CAJ | 학술논문

背景与目的小细胞肺癌对初始放化疗敏感，但容易复发或转移，生存率低。本研究目的在于探讨初治非手术小细胞肺癌复发/进展的影响因素，并分析复发/进展时间（无进展生存时间）（progression-free survival, PFS）与总生存时间（overall survival, OS）之间的相关性。方法回顾性分析182例于2009年1月-2011年12月在上海市胸科医院新诊断的住院并接受化疗联合/不联合放疗后出现复发/进展的非手术小细胞肺癌患者的临床资料，进行单因素和Cox回归多因素分析各种因素对PFS的影响。采用双变量相关分析来分析PFS与OS之间的关系。结果单因素分析显示发病时肿瘤TNM分期、是否肝转移、是否脑转移、一线化疗周期数、初始化疗疗效以及是否胸腔放疗对PFS有影响。发病时非脑转移患者中接受预防性颅脑照射（prophylactic cranial irradiation, PCI）与未接受PCI对PFS存在统计学差异。多因素分析表明一线化疗周期数、初始化疗疗效、胸腔放疗与否是影响PFS的独立因素。双变量相关分析显示PFS与OS存在显著正相关。结论一线化疗周期数多（大于4次）、初始化疗疗效好（部分缓解或完全缓解）、联合胸腔放疗以及非脑转移者行PCI可延长小细胞肺癌患者的PFS。
배경여목적소세포폐암대초시방화료민감，단용역복발혹전이，생존솔저。본연구목적재우탐토초치비수술소세포폐암복발/진전적영향인소，병분석복발/진전시간（무진전생존시간）（progression-free survival, PFS）여총생존시간（overall survival, OS）지간적상관성。방법회고성분석182례우2009년1월-2011년12월재상해시흉과의원신진단적주원병접수화료연합/불연합방료후출현복발/진전적비수술소세포폐암환자적림상자료，진행단인소화Cox회귀다인소분석각충인소대PFS적영향。채용쌍변량상관분석래분석PFS여OS지간적관계。결과단인소분석현시발병시종류TNM분기、시부간전이、시부뇌전이、일선화료주기수、초시화료료효이급시부흉강방료대PFS유영향。발병시비뇌전이환자중접수예방성로뇌조사（prophylactic cranial irradiation, PCI）여미접수PCI대PFS존재통계학차이。다인소분석표명일선화료주기수、초시화료료효、흉강방료여부시영향PFS적독립인소。쌍변량상관분석현시PFS여OS존재현저정상관。결론일선화료주기수다（대우4차）、초시화료료효호（부분완해혹완전완해）、연합흉강방료이급비뇌전이자행PCI가연장소세포폐암환자적PFS。
Background and objective Most small cell lung cancer (SCLC) patients relapse or progress and have low survival rate although they have signiifcant response to initial chemotherapy and radiotherapy. hTis study intends to explore the factors affecting the relapse (or progression) of nonoperative SCLC and to explore the correlations between progression-free survival (PFS) and overall survival (OS). Methods Clinical data of 182 patients diagnosed with SCLC between January 2009 and December 2011 at Shanghai Chest Hospital has been reviewed and retrospectively analyzed. All of these patients ac-cepted chemotherapy combined (or not combined) with radiotherapy, and relapsed or progressed atfer ifrst-line therapy. Uni-variate Kaplan-Meier survival estimates as well as multivariate Cox regression survival analysis were used to locate the potential factors affecting PFS. hTe correlation between PFS and OS was analyzed via Bivariate Correlation Analysis method. Results hTe univariate estimates showed that the TNM stage, liver metastasis or not, brain metastasis or not, ifrst-line chemotherapy cycles, effect of initial chemotherapy, and thoracic radiotherapy combined or not were the signiifcant contributive factors to PFS. In the subgroup of the patients without brain metastases, those received prophylactic cranial irradiation (PCI) had longer PFS. Cox regression indicated that the three independent variables of ifrst-line chemotherapy cycles, effect of initial chemo-therapy and thoracic radiotherapy combined or not were closely related to PFS. In addition, signiifcant positive correlation between PFS and OS had been observed. Conclusion PFS could be prolonged by having more ifrst-line chemotherapy cycles (>4 cycles), obtaining better effect of initial chemotherapy (partial response or complete response), combining with thoracic radiotherapy and implementing PCI for patients without brain metastasis.