DETERMINANTS OF IMPROVED OUTCOME IN SMALL-CELL LUNG-CANCER - AN ANALYSIS OF THE 2,580-PATIENT SOUTHWEST ONCOLOGY GROUP DATA-BASE
DETERMINANTS OF IMPROVED OUTCOME IN SMALL-CELL LUNG-CANCER - AN ANALYSIS OF THE 2,580-PATIENT SOUTHWEST ONCOLOGY GROUP DATA-BASE
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DOI：
10.1200/jco.1990.8.9.1563
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发表时间：
1990-09-01
影响因子：
45.3
通讯作者：
LIVINGSTON, RB
中科院分区：
文献类型：
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作者：
ALBAIN, KS;CROWLEY, JJ;LIVINGSTON, RB
我们分析了 1976 年至 1988 年 2,580 名西南肿瘤学组 (SWOG) 患者的小细胞肺癌数据库，目的是 (1) 使用 Cox 多变量分析确定局限期和广泛期疾病 (LD、ED) 中有利的人口统计学和肿瘤相关因素及治疗方案的预后价值，以及 (2) 使用递归分区和合并 (RPA) 分析定义生存率显着不同的患者亚组完善当前的两阶段系统。 Cox 多变量模型应用于六项 LD 试验中的 1,363 名患者：良好的体能状态、女性、年龄小于 70 岁、白人种族和正常的乳酸脱氢酶 (LDH) 是显着有利的独立预测因子。同步放化疗也是生存的一个强有力的独立预测因素。对于四项 ED 试验中的 1,217 名患者来说，正常的 LDH、强化多药治疗方案和单个转移性病变是 Cox 模型中有利的自变量。 最近 LD 和 ED 试验中对 1,137 名患者进行的 RPA 分析得出了一个回归树，其中最重要的预后分类是 LD 与 ED。 LDH 正常或异常、有无胸腔积液、年龄小于 70 岁或 .gtoreq。 70岁对于LD很重要，但只有LDH对于ED很重要。回归树的终端节点合并形成四个不同的预后亚组，中位生存期分别为 19.0、12.5、10.5 和 6.3 个月 (P < .0001)。最佳生存期出现在具有“真正”LD 的年轻患者身上：无积液且 LDH 正常。两个中间患者亚组患有 LD 或 ED，但仍比那些患有真正 ED（LDH 升高）的患者寿命显着更长。该分析表明，尽管 Cox 模型中的 LD 中有几个因素是独立的预后变量，但可以使用较少数量的变量通过 RPA 形成重要的预后亚组。 LDH 成为一个非常重要的因素，但表现状态和性别却不是。如果我们的结果可以通过组合组数据库分析来确认，则应该对当前的 stagina 系统进行改进。
We analyzed the 2,580-patient Southwest Oncology Group (SWOG) small-cell lung cancer data base from 1976 to 1988 in order to (1) determine the prognostic value of favorable demographic and tumor-related factors and therapy programs using Cox multivariate analyses in limited- and extensive-stage disease (LD, ED), and (2) define patient subgroups with significantly different survivals using recursive partitioning and amalgamation (RPA) analysis to refine the current two-stage system. Cox multivariate models were applied to 1,363 patients with six LD trials: good perfomance status, female sex, age less than 70 years, white race, and normal lactate dehdyrogenase (LDH) were significant favorable independent predictors. Concurrent chemoradiotherapy was also a strong independent predictor of survival. For 1,217 patients in four ED trials, a normal LDH, treatment with an intensive multidrug regimen, and a single metastatic lesion were favorable independent variables in the Coxmodel. RPA analysis of 1,137 patients in recent LD and ED trials resulted in a regression treee in which the most important prognostic split was LD versus ED. Normal or abnormal LDH, absence or presence of a pleural effusion, and age less than 70 or .gtoreq. 70 years were important in LD, but only LDH was significant in ED. The terminal nodes of the regression tree were amalgamated to form four distinct prognostic subgroups with median survivals of 19.0, 12.5, 10.5, and 6.3 months (P < .0001). The best survival occurred for younger patients with "true" LD: no effusion and normal LDH. The two intermediate patient subgroups had either LD or ED but still lived significantly longer than those patients with true ED (elevated LDH). This analysis suggests that although several factors were independent prognostic variables in LD in the Cox models, a smaller number of variables can be used to form important prognostic subgroups through RPA. The LDH emerged as a highly significant factor, but performance status and sex did not. A refinement of the current stagina system should be made if our results can be confirmed with a combined-group data base analysis.