319例晚期肺腺癌患者临床预后因素分析

目的：分析影响晚期肺腺癌患者的临床预后因素。方法回顾性研究319例Ⅲb ~Ⅳ期肺腺癌患者的临床资料，应用 Kaplan-Meier 方法计算生存率，采用 Cox 多因素回归对预后因素进行分析。结果319例患者的中位生存期为13.0个月，1、2、3 a 生存率分别为53.0%、26.1%、18.1%。单因素分析显示 PS 评分，治疗前外周血红蛋白、白蛋白及中性粒细胞，TNM 分期，首诊伴骨、肝、脑转移及转移器官数目，一线化疗周期数，是否应用 EGFR-TKI 与晚期肺腺癌患者生存有关（P ﹤0.05）。多因素分析显示 PS 评分，治疗前外周血红蛋白、白蛋白、中性粒细胞，TNM 分期，首诊伴脑转移，转移器官数目，一线化疗周期数及 EGFR-TKI的应用与晚期肺腺癌患者生存有关（P ﹤0.05）。在对接受 EFGR-TKI 治疗的83例患者的亚组分析中发现，既应用 EFGR-TKI 又接受化疗者的中位生存期最长，但各亚组间生存期差异无统计学意义（ P ﹥0.05）。结论 PS 评分，治疗前外周血红蛋白、白蛋白、中性粒细胞，TNM 分期，首诊伴脑转移，转移器官数目，一线化疗周期数及 EFGR-TKI 的应用是影响晚期肺腺癌患者预后的独立危险因素。EFGR-TKI 的应用可以为晚期肺腺癌患者带来生存获益，既应用 EFGR-TKI 又化疗的患者可能为获益最大。

Analysis of Clinical Prognostic Determinants of 319 Patients with Advanced Lung Adenocarcinoma

Objective To investigate the cilinical prognostic factors of advanced lung adenocarcinoma. Methods The clinical data of 319 patients with Ⅲb or IV lung adenocarcinoma were collected. The survival rate was evalua-ted by Kaplan-Meier method. The prognosis were analyzed by Cox multivariate regression. Results The median sur-vival time of 319 patients was 13. 0 months. One,two and three-year survival rates were 53. 0% ,26. 1% ,18. 1% re-spectively. Univariate analysis showed that PS scores,baseline serum hemoglobin level,baseline serum albumin lev-el,baseline serum neutrophil level,TNM stage,bone metastasis,hepatic metastasis,brain metastasis at initial diagno-sis,numbers of metastatic organs,first-line chemotherapy periodicity and therapy with EGFR-TKI had influence on the overall survival of patients with advanced lung adenocarcinoma(P ﹤ 0. 05). Cox multivariate analysis showed that PS scores,baseline serum hemoglobin level,baseline serum albumin level,baseline serum neutrophil level,TNM stage,brain metastasis at initial diagnosis,numbers of metastatic organs,first-line chemotherapy periodicity and ther-apy with EGFR-TKI were independent prognostic factors(P ﹤ 0. 05). In subgroup analysis of 83 patients with ad-vanced lung adenocarcinoma treated with EGFR-TKI,median survival time for patients who received chemotherapy and EGFR-TKI was the longest in all subgroups,presenting no significant difference in each subgroup(P ﹥ 0. 05). Conclusion PS scores,baseline serum hemoglobin level,baseline serum albumin level,baseline serum neutrophil level,TNM stage,brain metastasis at initial diagnosis,numbers of metastatic organs,first-line chemotherapy periodic-ity and therapy with EGFR-TKI were independent prognostic factors for the overall survival of advanced lung adeno-carcinoma. The application of EGFR-TKI has extended the lives of patients of advanced lung adenocarcinoma and the patients with treatment history of EGFR-TKI and chemotherapy may benefit most from this kind of treatment mo-dality.