Prognostic Significance of Pretreatment Laboratory Parameters in Combined Small-Cell Lung Cancer
Prognostic Significance of Pretreatment Laboratory Parameters in Combined Small-Cell Lung Cancer
复制标题
联合小细胞肺癌治疗前实验室参数的预后意义
DOI：
10.1007/s12013-014-9845-3
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发表时间：
2014-07-01
影响因子：
2.6
通讯作者：
Li, Kai
中科院分区：
文献类型：
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作者：
Wang, Xinyue;Jiang, Richeng;Li, Kai
尽管近年来联合小细胞肺癌(C-SCLC)的发病率呈上升趋势，但有关C-SCLC患者临床预后因素的研究资料尚不多见。在本研究中，我们寻找C-SCLC的预处理特征，特别是预测C-SCLC存活的基本实验室参数。我们分析了我们机构2005年1月至2010年12月期间的613例小细胞肺癌(SCLC)患者。我们确定了114例C-SCLC患者。复习了这些患者的病理和临床特点。检查这些患者确诊时常规检查中获得的实验室参数数据。采用Kaplan-Meier法计算存活率，绘制生存曲线。用COX回归模型分析影响总生存期的独立因素。这些数据与同期499例单纯小细胞肺癌患者的结果进行了比较。在分析的613例小细胞肺癌患者中，18.6%的患者表现为C-SCLC。C-SCLC患者与单纯小细胞肺癌患者的OS差异无统计学意义(P=0.995)。Kaplan-Meier生存曲线显示，低分化组(P<；0.001)、广泛性疾病(P<；0.001)、SC/LC病理亚型(P<；0.001)、未接受手术(P=0.001)、血清乳酸脱氢酶升高(P=0.005)、神经特异性烯醇化酶升高(P=0.043)、中性粒细胞/淋巴细胞比率升高(P=0.018)与C-SCLC患者预后不良相关。经多因素分析，C-SCLC患者的OS受ECOG-PS(危险比2.001，P=0.012)、疾病程度(危险比3.406，P=0.001)和NLR(危险比1.704，P=0.030)的影响，而影响单纯小细胞肺癌患者预后的危险因素有ECOG-PS(危险比2.132，P=0.001)、疾病程度(危险比1.482，P<；0.001)和乳酸脱氢酶(危险比1.811，P<；0.001；(0.001)。C-SCLC患者的预后与单纯小细胞肺癌患者相似。在判断C-SCLC患者的预后时，除考虑病情程度和功能状态外，还应考虑易于获得的治疗前参数，如NLR。
Despite the increasing incidence of combined small-cell lung cancer (C-SCLC) in recent years, there have not been many data on clinical prognostic factors predicting prognosis of C-SCLC patients. In present study, we sought pretreatment features especially basic laboratory parameters predicting survival of C-SCLC. We analyzed 613 small-cell lung cancer (SCLC) patients at our institution between January 2005 and December 2010. We identified 114 patients with C-SCLC. The pathologic and clinical characteristics of these patients were reviewed. Data of laboratory parameters obtained during regular examinations at diagnosis of these patients were examined. The Kaplan–Meier method was used to calculate the survival rate and depict the survival curves. The Cox regression model was used to analyze the independent factors affecting the overall survival (OS). These data were compared with the results obtained from our 499 pure SCLC patients who presented during the same time period. Of the 613 SCLC patients analyzed, 18.6 % of the patients presented with C-SCLC. No difference in OS was observed in patients with C-SCLC and patients with pure SCLC (P= 0.995). The Kaplan–Meier survival curves revealed that poor ECOG-PS (P< 0.001), extensive disease (P< 0.001), pathologic subtype of SC/LC (P< 0.001), not receiving surgery (P= 0.001), elevated serum lactate dehydrogenase (LDH) (P= 0.005), elevated NSE (P= 0.043), and elevated neutrophile–lymphocyte ratio (NLR) (P= 0.018) were associated with adverse prognosis of patients with C-SCLC. By multivariate analysis, OS was affected by ECOG-PS (hazard ratio 2.001,P= 0.012), disease extent (hazard ratio 3.406,P< 0.001), and NLR (hazard ratio 1.704,P= 0.030) in C-SCLC patients, while the risk factors that influenced the prognosis of the patients with pure SCLC were ECOG-PS (hazard ratio 2.132,P< 0.001), disease extent (hazard ratio 1.482,P< 0.001), and LDH (hazard ratio 1.811,P< 0.001). Patients with C-SCLC carry a similar prognosis than those with pure small-cell variety. Easily accessible pretreatment parameters such as NLR should be considered in defining the prognosis of C-SCLC patients besides disease extent and performance status.