小细胞肺癌临床特征与治疗疗效相关研究.doc

学科代码03b小细胞肺癌临床特征与治疗疗效相关性研究丁翠敏，郑辉辉河北医科大学第四医院，呼吸内科,056000【摘要】目的：本研究将从小细胞肺癌（SCLC）患者的临床特征等方面着手分析其与SCLC一线治疗中位无进展生存期（PFS）的关系，进而为探讨小细胞肺癌的预后因素和延长生存提供依据。方法：收集2006年2月至2013年4月就诊于我院呼吸内科，并证实为小细胞肺癌患者，按要求记录患者的临床资料。对52例SCLC患者进行随访，并计算一线治疗的中位PFS，并分析其与患者临床特征、治疗前血清钠、NSE水平及放疗时机的关系。采用Mann-Whitney U非参数秩和检验比较不同临床特征的患者一线治疗的PFS的差异，P0.05表示差异有统计学意义。结果：1 本研究中男性患者39例，占75%，女性患者13例，占25%；60岁的患者29例，占55.8%，60岁的患者23例，占44.2%；吸烟者30例，占57.7%，不吸烟者22例，占42.3%；局限期患者25例，占48.1%，广泛期患者27例，占51.9%。治疗前血钠135mmol/L者17例，占44.7%，血钠正常者21例，占55.3%。NSE16.3ng/ml者36例，占97.3%，16.3ng/ml者1例，占0.7%；37例患者NSE平均值为95ng/ml。NSE95ng/ml者28例，占75.7 %，95ng/ml 者9例，占24.3%；经2周期化疗后NSE恢复正常者15例，约占60%，NSE仍高者10例，占40%。早放疗（化疗3周期以前行放疗）者10例，占58.8%，晚放疗（化疗3周期及3周期以后行放疗）者7例，占41.2%。 2 39例男性患者中位PFS为7个月，13例女性患者中位PFS为10个月，两组间比较P=0.022；29例60岁者中位PFS为8个月，23例60岁者中位PFS为9个月, 两组间比较P=0.322；30例吸烟者中位PFS为7个月，22例不吸烟者中位PFS为9.5个月，两组间比较P=0.163；25例局限期患者中位PFS为9个月，27例广泛期患者中位PFS为7个月，两组间比较P=0.037。3 本研究中治疗前NSE95 ng/ml者28例，其中位PFS为9个月； NSE95ng/ml者10例, 其中位PFS为5个月，两组间比较P=0.014。化疗2周期后NSE恢复正常者15例，其中位PFS为10个月；NSE仍高者的中位PFS为8.5个月，两组间比较P0.179。4 血清钠135mmol/L者17例，其中位PFS为7个月；血清钠正常者21例，其中位PFS为8个月，两组间比较P0.340。5 10例早放疗者中位PFS为10个月；7例晚放疗者中位PFS为9个月。两组间比较P0.163。结论：1 本研究表明年龄、吸烟状况、治疗前血钠水平与小细胞肺癌一线治疗的PFS无关。2 治疗前NSE水平与小细胞肺癌一线治疗的PFS相关，NSE95ng/ml者明显好于NSE95ng/ml者。3 性别是SCLC 患者一线治疗PFS的预测因素，女性患者明显好于男性患者。4 临床分期是SCLC患者一线治疗PFS的预测因素，局限期明显好于广泛期。5 早放疗者一线治疗PFS较晚放疗者有延长趋势。 【关键字】：小细胞肺癌；临床特征；血清钠；NSE；放疗时间；PFS；预后The study on the clinical features of patients with small cell lung cancer and the correlation between therapeutic effectDing Cuimin,Zheng HuihuiThe fourth hospital of Hebei medical university,the respiratory department【ABSTRACT】Objective: This study will start from the clinical features of SCLC patients and so on to investigate the prognostic factors and to provide better the basis for the improvement of survival and prognosis in patients .Methods: The 52 cases of small cell lung cancer patients were collected that were hospitalized in the respiratory department from February 2006 to April 2013. We record the clinical information for all patients.The Mann - Whitney U nonparametric rank and inspection is a first-line treatment in patients with different clinical features of PFS difference, P 0.05, said the difference was statistically significant.Results：1 In this study, 39 cases of male patients , accounted for 75%, 13 case of female patients, accounted for 25%; 60 years old in 29 cases, accounted for 55.8%, 23 patients with 60 or older, accounted for 44.2%; 30 cases of smokers accounted for 57.7%, 22 cases of nonsmokers, accounted for 42.3%; 25 patients with limit stage, accounted for 48.1%, 27 patients with extensive stage, accounted for 51.2%.17 cases of patients with serum sodium 16.3ng/ml in 36 cases, accounted for 97.3%, 16.3ng/ml in 1 case, accounted for 0.7%; the average value 95ng/ml. NSE95ng/ml in 9 cases, accounted for 24.3%; after the 2 cycle of chemotherapy return to normal is 15 cases, accounted for 60%, 10 cases of NSE is 16.3ng/ml, accounted for 40%.Three cycles of chemotherapy to radiotherapy is defined as early radiotherapy, a total of 10 cases (58.8%), and chemotherapy cycle after three cycles and 3 radiations is defined as late radiation, a total of 7 cases, accounting for 41.2%.2 male patients with 39 cases, including a PFS for 7 months, 13 cases of female patients, including a PFS for 10 months, P=0.022;29 cases of patients with 60 years old, including a PFS for 8 months; 23 cases of patients with60 years old, including a PFS for 9 months, P = 0.322; 30 cases of smokers, including a PFS for 7 months; 22 cases of nonsmokers, including a PFS for 9.5 months, P=0.163; 25 cases of patients with limited stage, including a PFS for 9 months, 27 patients with extensive stage, including a PFS for 7 months, P = 0.037.3 28 cases of patients with 95ng/ml, including a PFS for 9 months, 10 cases of patients with NSE 95ng/ml, including a PFS for 5 months, P = 0.014.After 2 cycles of chemotherapy , 15 cases of patients with NSE restored normal , including a PFS for 10 months;10 cases of patients with NSE still higher including a PFS for 8.5 months, P = 0.179.17 cases of patients with serum sodium 0.05.Conclusions：1 this study shows that age, smoking status, sodium levels before treatment with PFS of first-line treatment of small cell lung cancer is independent.2 NSE levels before treatment with PFS of first-line treatment of small cell lung cancer-related, NSE95ng/ml is significantly better than NSE 95ng / ml .3 Sex is predictor of PFS the first-line treatment of SCLC patients female patients is significantly better than male patients.4 Clinical stages is a predictor of SCLC patients treated first-line PFS, for limited stage was significantly better than extensive stage .5