CAJ | 학술논문

目的：分析肺癌恶性胸腔积液的诊治特点及疗效评估,探讨其预后因素及有效的诊治方案。方法回顾性分析2009年10月至2013年12月该院收治的临床诊断肺癌恶性胸腔积液患者728例的临床资料,随访至2014年9月30日。对可供分析的有效随访肺癌恶性胸腔积液患者438例的诊治情况进行分析。主要观察指标为发生率、有效率、无进展生存期和总生存期。结果肺癌恶性胸腔积液总体中位无进展生存期为4个月,中位生存期8个月。多变量 Logistic 回归分析表明,男性、小细胞肺癌、胸腔积液大量、右侧胸腔积液可能是恶性胸腔积液局部难控制的独立因素。胸腔积液4周可控制患者总生存优于难控制者(中位生存时间：9个月vs.5个月,P<0.001)。胸腔积液2周控制率与4周控制率总生存预后无明显差异。多变量 Cox回归分析表明,组织学类型、局部缓解时间、化学治疗周期数和酪氨酸激酶抑制剂(TKI)治疗是进展风险的独立预测因素。鳞癌和其他组织学类型患者的进展风险低于腺癌(P=0.007)。胸腔积液4周内缓解患者的进展风险显著低于未缓解者(P=0.004)。完成化学治疗周期数大于2周期以及服用TKI治疗的患者进展风险都显著降低(P<0.001；P=0.026)。对总生存期而言,女性、鳞癌、不伴心包积液、3周期及以上化学治疗、TKI治疗、胸腔积液4周内可控制的患者总生存预后较好。结论男性、胸腔积液大量、右侧胸腔积液是恶性胸腔积液局部难控制的独立预后因素。胸腔积液局部可控制患者总生存优于难控制者。组织学类型、胸腔积液可控缓解时间、化学治疗周期数和TKI治疗是肺癌恶性胸腔积液的进展风险和总生存的独立预测因素。
목적：분석폐암악성흉강적액적진치특점급료효평고,탐토기예후인소급유효적진치방안。방법회고성분석2009년10월지2013년12월해원수치적림상진단폐암악성흉강적액환자728례적림상자료,수방지2014년9월30일。대가공분석적유효수방폐암악성흉강적액환자438례적진치정황진행분석。주요관찰지표위발생솔、유효솔、무진전생존기화총생존기。결과폐암악성흉강적액총체중위무진전생존기위4개월,중위생존기8개월。다변량 Logistic 회귀분석표명,남성、소세포폐암、흉강적액대량、우측흉강적액가능시악성흉강적액국부난공제적독립인소。흉강적액4주가공제환자총생존우우난공제자(중위생존시간：9개월vs.5개월,P<0.001)。흉강적액2주공제솔여4주공제솔총생존예후무명현차이。다변량 Cox회귀분석표명,조직학류형、국부완해시간、화학치료주기수화락안산격매억제제(TKI)치료시진전풍험적독립예측인소。린암화기타조직학류형환자적진전풍험저우선암(P=0.007)。흉강적액4주내완해환자적진전풍험현저저우미완해자(P=0.004)。완성화학치료주기수대우2주기이급복용TKI치료적환자진전풍험도현저강저(P<0.001；P=0.026)。대총생존기이언,녀성、린암、불반심포적액、3주기급이상화학치료、TKI치료、흉강적액4주내가공제적환자총생존예후교호。결론남성、흉강적액대량、우측흉강적액시악성흉강적액국부난공제적독립예후인소。흉강적액국부가공제환자총생존우우난공제자。조직학류형、흉강적액가공완해시간、화학치료주기수화TKI치료시폐암악성흉강적액적진전풍험화총생존적독립예측인소。
Objective To analyze the characteristics of diagnosis and therapeutic effect of malignant pleural effusion with lung cancer,and explore the prognostic factors and effective diagnosis and treatment plans.Methods A retrospective analysis in-cludes 728 cases of definite pleural effusion with lung cancer from October 2009 to December 2013 in our hospital,which was fol-lowed-up to September 30,2014,and 438 cases were available analyzed.The main outcome measures were incidence,efficiency,pro-gression-free survival and overall survival.Results The overall median progression-free survival and the median survival of malig-nant pleural effusions with lung cancer was respectively 4 months and 8 months.males,small cell lung cancer,massive pleural effu-sion,and right pleural effusion may be the independent factors of local unmanageable malignant pleural effusion by multivariable Lo-gistic regression.The overall survival of pleural effusion with locally control(less than four weeks )was better than those with un-manageable(mOS:9 month vs.5 month,P<0.001).It was no significant difference of the control rate for overall survival prognosis between pleural effusion with two weeks and those with four weeks.histological type,partial remission time,the number of cycles of chemotherapy and TKI therapy may be the independent development risk by progression with Multivariate Cox regression analysis. the progress risk of patients with squamous cell carcinoma and other histological types were lower than that of adeno carcinoma (P=0.007).The progress risk of development of patients with 4 weeks of pleural effusion was significantly lower than that of the non remission (P=0.004),the progress risk of complete chemotherapy cycle number > 2 cycles and takingTKI treatment were significantly reduced (P<0.001;P=0.026).Gender,histological type,pericardial effusion,partial remission time,cycles of chemo-therapy and TKI were the independent prognostic factors for overall survival.The overall survival prognosis of patients with Fe-male,squamous cell carcinoma,no pericardial effusion,and over three cycles of chemotherapy,TKI therapy,and local controlled in 4 weeks was better.Conclusion Male,massive pleural effusion and right pleural effusion are independent predictive factors of local unmanageable malignant pleural effusion.The overall survival of pleural effusion with locally control was better than the patients with refractory control.Histological type,controllable relief time of pleural effusion,cycles of chemotherapy and TKI therapy were the independent predictive factors of progression and overall survival.