合并症对老年非小细胞肺癌患者预后及生存的影响

目的探讨Charlson合并症指数(CCI)和简化合并症评分(SCS)两种方法评估合并症对老年非小细胞肺癌(NSCLC)患者预后生存的影响。方法回顾分析2005年1月至2006年12月中国医学科学院肿瘤医院收治的693例65岁以上老年NSCLC患者的临床资料,随访生存情况,分析患者年龄、性别、吸烟状况、Karnofsky评分(KPS)、TNM分期、病理类型、治疗方式、合并症情况(CCI、SCS)等因素;应用Kaplan-Meier方法分析单因素对生存期的影响;采用log-rank法检验比较生存期之间的差异;多因素分析采用Cox比例风险模型。结果 693例患者平均年龄70.4±4.0岁(65～86岁),确诊肺癌后中位生存时间为34.0个月(0.2～84.0个月),5年生存率为35.4%。单因素分析结果显示,吸烟状况、KPS、治疗方式、TNM分期、SCS与预后相关。Cox多因素分析显示,TNM分期、治疗方式、SCS是影响患者生存及预后的独立因素。结论 TNM分期、治疗方式、合并症等多种因素影响老年NSCLC患者的预后生存。老年肺癌患者多伴有合并症,SCS方法也许更适用于评估合并症对NSCLC的影响。重视并控制合并症,有助于改善预后,延长生存。

Prognostic impact of comorbidity in elderly patients with non-small cell lung cancer

Objective This study aimed at validating the Charlson comorbidity index(CCI) and Simplified comorbidity score(SCS) in elderly patients with Non-small cell lung cancer(NSCLC),and assess the impact of comorbidity on prognosis and survival.Methods We retrospectively reviewed 693 patients with NSCLC who were hospitalized in The Cancer Hospital of Chinese Academy of Medical Sciences between January 2005 and December 2006.All the potential prognostic factors,including gender,age,smoking status,pathological type,clinical stage,Karnofsky performance score(KPS),CCI,SCS and therapeutic method were evaluated.Univariate analysis by Kaplan-Mierer combining with log-rank test and multivariate Cox regression model was used to determine the significance of prognostic variables in the survival.Results Of all the patients,the median survival was 34.0 months(0.2-84.0 months) and the five-year survival rate was 35.4%.Univariate analysis revealed that smoking status,clinical stage,KPS,SCS and therapeutic method were factors significantly related to prognosis and survival in elderly NSCLC.Multivariable analysis showed that clinical stages,SCS,therapeutic method were independent prognostic factors.Conclusions Clinical stages,SCS,therapeutic method may be independent prognostic factors of NSCLC in the elderly.The SCS appears more informative than the CCI in predicting NSCLC patient outcome.Comorbidities might be taken into account as an important variable on treatment of NSCLC.