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目的回顾性分析根治性放射治疗的非小细胞肺癌（ＮＳＣＬＣ）病例，探讨影响放射治疗非小细胞肺癌预后的因素。方法选择１９９０年１月～１９９６年１２月间根治性放射治疗并经病理确诊的Ⅰ～Ⅲｂ期ＮＳＣＬＣ患者２５６例，生存统计采用ＫａｐｌａｎＭｅｉｅｒ法及Ｌｏｇｒａｎｋ检验，多因素分析采用Ｃｏｘ逐步回归模型。以多因素分析时各因素的变异系数乘以分组值计算预后指数。结果全组中位生存时间１４．５个月，１，３，５年生存率分别为６０％，２１％和７％。单因素和多因素分析均显示临床分期早；在较短的总疗程时间内接受较高剂量的照射；病理类型为鳞癌和放射治疗前细胞免疫状态较好的患者预后较好。综合以上４种因素的预后指数模型能够较好地区分不同的预后亚组。结论临床分期、放射治疗方法、病理类型和放射治疗前细胞免疫状态是放射治疗ＮＳＣＬＣ的独立预后因素。预后指数模型能够比ＴＮＭ分期等单个因素更好地反映预后。
Objective To retrospectively analyze the cases of non-small cell lung cancer (NSCLC) with curative radiotherapy and explore the factors affecting the prognosis of NSCLC. Methods A total of 256 patients with stage I-IIIb NSCLC who underwent radical radiotherapy between January 1990 and December 1996 and were pathologically confirmed were selected. Kaplan-Meier method and Logrank test were used for survival analysis. Cox regression was used for multivariate analysis. model. Multivariate analysis was used to calculate the prognostic index by multiplying the coefficient of variation of each factor by the grouping value. Results The median survival time was 14.5 months. The 1-, 3-, and 5-year survival rates were 60%, 21%, and 7%, respectively. Both univariate and multivariate analysis showed that the clinical stage was early; higher doses of radiation were received during the shorter total course of time; patients with better cellular immune status before squamous cell carcinoma and radiation therapy had better prognosis. The prognostic index model combining the above four factors can better distinguish different subgroups of prognosis. Conclusions Clinical staging, radiation therapy, pathological types, and pre-radiotherapy cellular immune status are independent prognostic factors for radiotherapy of NSCLC. The prognostic index model can better reflect the prognosis than individual factors such as TNM staging.