CAJ | 학술논문

背景与目的小细胞肺癌（small cell lung cancer, SCLC）是恶性程度极高的神经内分泌肿瘤，对放化疗敏感。目前，广泛期SCLC的一线标准化疗方案为铂类联合依托泊苷方案，但大多数接受一线化疗的患者在1年-2年内复发。一旦疾病复发，预后不良。本研究旨在研究广泛期SCLC总体和一线化疗的生存情况及其影响因素。方法收集2001年2月-2011年12月经病理学或细胞学确诊为广泛期的SCLC患者394例，采用Kaplan-Meier法计算总生存时间（overall survival, OS）和无进展生存时间（progression-free survival, PFS）并绘制生存曲线，单因素及Cox回归多因素分析各种因素对生存期的影响。结果全组中位OS为14.8个月，1年、2年、5年生存率分别为58.9%、27.2%、7.8%。全组OS与年龄（P=0.006）、ECOG评分（P=0.021）、肝转移（P<0.001）、骨转移（P<0.001）、是否化疗（P<0.001）密切相关。一线化疗广泛期SCLC患者的中位OS为15.1个月，中位PFS为7.5个月。多因素分析结果显示一线化疗广泛期SCLC的OS与吸烟（P=0.041）、肝转移（P<0.001）、骨转移（P<0.001）、化疗疗程数（P<0.001）相关；一线化疗PFS与吸烟（P=0.003）、肝转移（P=0.001）、骨转移（P<0.001）、化疗疗程数（P<0.001）相关。胸部放疗并非广泛期SCLC OS和PFS的独立影响因素。结论年龄<60岁、体能状况好、无肝、骨转移的广泛期SCLC患者预后更好。广泛期SCLC患者应积极进行化疗，一线化疗的化疗疗效达到部分缓解-完全缓解有益于生存；适合的化疗疗程数目是4-6疗程。胸部放疗在广泛期SCLC治疗中的作用需要进一步研究。
배경여목적소세포폐암（small cell lung cancer, SCLC）시악성정도겁고적신경내분비종류，대방화료민감。목전，엄범기SCLC적일선표준화료방안위박류연합의탁박감방안，단대다수접수일선화료적환자재1년-2년내복발。일단질병복발，예후불량。본연구지재연구엄범기SCLC총체화일선화료적생존정황급기영향인소。방법수집2001년2월-2011년12월경병이학혹세포학학진위엄범기적SCLC환자394례，채용Kaplan-Meier법계산총생존시간（overall survival, OS）화무진전생존시간（progression-free survival, PFS）병회제생존곡선，단인소급Cox회귀다인소분석각충인소대생존기적영향。결과전조중위OS위14.8개월，1년、2년、5년생존솔분별위58.9%、27.2%、7.8%。전조OS여년령（P=0.006）、ECOG평분（P=0.021）、간전이（P<0.001）、골전이（P<0.001）、시부화료（P<0.001）밀절상관。일선화료엄범기SCLC환자적중위OS위15.1개월，중위PFS위7.5개월。다인소분석결과현시일선화료엄범기SCLC적OS여흡연（P=0.041）、간전이（P<0.001）、골전이（P<0.001）、화료료정수（P<0.001）상관；일선화료PFS여흡연（P=0.003）、간전이（P=0.001）、골전이（P<0.001）、화료료정수（P<0.001）상관。흉부방료병비엄범기SCLC OS화PFS적독립영향인소。결론년령<60세、체능상황호、무간、골전이적엄범기SCLC환자예후경호。엄범기SCLC환자응적겁진행화료，일선화료적화료료효체도부분완해-완전완해유익우생존；괄합적화료료정수목시4-6료정。흉부방료재엄범기SCLC치료중적작용수요진일보연구。
Background and objective Small cell lung cancer (SCLC) is the most malignant neuroendocrine tumor but highly sensitive to chemotherapy and radiotherapy. At present, the standard ifrst-line chemotherapy regimen of extensive-stage SCLC is platinum combined etoposide regimen. However, most patients who receive ifrst-line chemotherapy will relapse within one to two years. Once recurrent, it indicates poor prognosis. In this study, we analyzed the survival among all extensive-stage SCLC and patients who received ifrst-line chemotherapy and determined prognostic factors. Methods Total of 394 patients who were diagnosed as extensive-stage small cell lung cancer from February 2001to December 2011hospitalized in Peking Union Medical College Hospital were collected. Kaplan-Meier method was used to calculate the overall survival (OS) and progression-free survival (PFS). Univariate analysis and Cox regression analysis were used to detect the inlfuence factors of survival. Results hTe median OS of all extensive-stage small cell lung cancer was14.8 months;1-year, 2-year and 5-year survival rates were 58.9%, 27.2%and 7.8%, respectively. According to the results of univariate and Cox multivariate analysis, OS of extensive-stage SCLC was closely associated with age (P=0.006), ECOG PS (P=0.021), liver metastasis (P<0.001), bone metastasis (P<0.001) and chemotherapy (P<0.001). hTe mortality risk of patients who didn’t receive chemotherapy was 4.919 times higher than that who received;the mortality risk of patients without liver, bone metastasis was reduced by approximately 50 percent. hTe ifrst-line chemotherapy was mainly EP (DDP+VP-16) or CE (CBP+VP-16) regimens (accounting for 82.8%) with 4-6 cycles. hTe median OS and PFS in ifrst-line chemotherapy were15.1months and 7.5 months, respectively. hTe result of Cox regression analysis indicated that OS in ifrst-line chemotherapy was remarkably related to smoking history (P=0.041), liver metastasis (P<0.001), bone metastasis (P<0.001), chemotherapy cycle number (P<0.001);PFS was relevant with smoking history (P=0.003), liver metastasis (P=0.001), bone metastasis (P<0.001), chemotherapy cycle number (P<0.001). hToracic radiotherapy was not an independent inlfuence factor of OS and PFS in extensive-stage small cell lung cancer. Con-clusion hTe patients who were younger than 60-year old, with good KPS, absence of liver and bone metastasis had better prognosis. Patients should receive chemotherapy with ifrst-line standard regimen (CE/EP regimen). It was beneifcial to sur-vival if the effect of ifrst-line chemotherapy was SD or PR-CR and the proper chemotherapy cycle number was 4-6 cycles. hTe role of thoracic radiotherapy in extensive-stage small cell lung cancer needed to be investigated further.