Selected patients can benefit more from the management of etoposide and platinum-based chemotherapy and thoracic irradiation-a retrospective analysis of 707 small cell lung cancer patients.
Selected patients can benefit more from the management of etoposide and platinum-based chemotherapy and thoracic irradiation-a retrospective analysis of 707 small cell lung cancer patients.
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部分患者可从依托泊苷和铂类化疗及胸部放疗的治疗中获益——707例小细胞肺癌患者的回顾性分析
DOI：
10.18632/oncotarget.14395
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发表时间：
2017-01-31
期刊：
影响因子：
--
通讯作者：
Yu Y
中科院分区：
文献类型：
--
作者：
Cao S;Jin S;Shen J;Cao J;Zhang H;Meng Q;Wang C;Zhang A;Zhang P;Yu Y
小细胞肺癌（SCLC）的治疗已经达到了一个平台期。依托泊苷和铂基化疗加胸部放疗仍然是SCLC的标准治疗策略。我们的研究旨在评估依托泊苷和铂基化疗患者的潜在预后因素，并探讨哪一组患者从标准治疗策略中获益更多。单因素分析中，年龄bbb65岁、男性、KPS (Karnofsky Performance Status)≤80分、吸烟史阳性、贫血、淋巴细胞计数≤1.65×109/L、中性粒细胞与淋巴细胞比值(NLR)>3.18、淋巴细胞与单核细胞比值(LMR)≤2.615、乳酸脱氢酶(LDH)>216.5 U/L、碱性磷酸酶(ALP)>119.5 U/L、未行手术、未行胸部放疗、化疗周期<4、转移部位≥2、病变广泛与预后不良相关。性别、KPS、化疗周期、胸部放疗、转移部位、LDH、肿瘤分期多因素分析差异均有统计学意义（p<0.05）。高LDH与疾病广泛、转移部位≥2、贫血、低LMR、高NLR和ALP水平密切相关。亚组分析显示，男性、KPS≤80分、LDH≤216.5U/L、疾病广泛且转移部位<2的患者在≥4个化疗周期中获益更多。男性、KPS> ~ 80分、LDH≤216.5U/L、病变受限、转移部位<2的患者更能从胸部放疗中获益（单因素和多因素分析p<0.05）。综上所述，女性患者、KPS>80分、化疗周期≥4个、胸部放疗、转移部位<2个、LDH≤216.5U/L、病情受限是依托泊苷+铂类化疗治疗SCLC患者独立的阳性预后因素。选定的患者可以从≥4个周期的化疗和胸部放疗中获益更多。
The management of small cell lung cancer (SCLC) has reached a plateau. Etoposide and platinum-based chemotherapy plus thoracic irradiation remain the standard treatment strategy for SCLC. Our study aims to assess the potential prognostic factors of patients treated with etoposide and platinum-based chemotherapy and explore which group of patients can benefit more from standard treatment strategies. On univariate analysis, age>65 years, male patients, KPS (Karnofsky Performance Status)≤80 points, positive smoking history, anemia, lymphocyte counts≤1.65×109/L, neutrophil to lymphocyte ratio (NLR)>3.18, lymphocyte to monocyte ratio (LMR)≤2.615, lactate dehydrogenase (LDH)>216.5 U/L, alkaline phosphatase (ALP)>119.5 U/L, absence of surgery, absence of thoracic irradiation, chemotherapy cycles<4, metastatic sites≥2 and extensive disease were correlated with a poor prognosis. Gender, KPS, chemotherapy cycles, thoracic irradiation, metastatic sites, LDH and tumor stage held statistical significance on multivariate analysis (p<0.05). High LDH was closely correlated with extensive disease, metastatic sites≥2, anemia, low LMR, high NLR and ALP levels. Subgroup analysis showed patients with male gender, KPS≤80 points, LDH≤216.5U/L, extensive disease and metastatic sites<2 could benefit more from ≥4 chemotherapy cycles. Patients with male gender, KPS>80 points, LDH≤216.5U/L, limited disease and metastatic sites<2 could benefit more from thoracic irradiation (p<0.05 on uni- and multivariate analysis). In conclusion, female patients, KPS>80 points, chemotherapy cycles≥4, thoracic irradiation, metastatic sites<2, LDH≤216.5U/L and limited disease were independent positive prognostic factors for SCLC patients treated with etoposide and platinum-based chemotherapy. Selected patients can benefit more from the management of ≥4 cycles of chemotherapy and thoracic irradiation.