Ⅲ期小细胞肺癌年轻患者的肿瘤特异性生存优势

doi:10.6040/j.issn.1671-7554.0.2019.849

摘要/Abstract

摘要： 目的考察年龄对小细胞肺癌(SCLC)患者预后评估的价值。方法登陆监测、流行病学及最终结果(SEER)登记系统,查询2010年1月至2013年12月的所有SCLC病例(n=17 237)。青年组定义为年龄≤49岁的患者(n=733),中年组定义为50~64岁的患者(n=6 332),老年组定义为年龄≥65岁的患者(n=10 172)。分析各组患者的临床病理特征,获取肿瘤特异性生存(CSS)等数据,应用Kaplan-Meier法及多变量Cox回归模型进行统计分析。结果单因素及多因素分析均显示,随着年龄的增加,CSS缩短(χ2=342.08, P<0.001),其中青年组患者的OS(χ2=203.90, P<0.001)和CSS(χ2=160.50, P<0.001)均提高。中年组风险比(HR)为1.177(95%CI:1.068~1.296, P=0.001),老年组HR为1.643(95%CI:1.495~1.807, P<0.001)。在Ⅰ期(P=0.015)、Ⅲ期(P<0.001)、Ⅳ期(P<0.001)或接受非手术治疗(P<0.001)的患者中,年龄越小,CSS越具优势。结论年龄≤49岁的SCLC患者较更年长患者具有生存优势;在Ⅲ期及接受非手术治疗的患者中,年龄具有较明确的预后价值。

关键词: 小细胞肺癌, 年轻, 肿瘤特异性生存, 监测、流行病学及最终结果登记系统

Abstract: Objective To estimate the prognostic value of age on small cell lung cancer(SCLC)patients. Methods The Surveillance, Epidemiology, and End Results(SEER)population-based data was queried for SCLC patients from Jan. 2010 to Dec. 2013, and 17 237 cases were enrolled. The cases ≤ 49 years were defined as young group(n=733), 50-64 years were defined as middle-aged group(n=6 332), and the cases ≥ 65 years were defined as elderly group(n=10 172). Clinicopathological characteristics of patients were analyzed. Cancer-specific survival(CSS)data were obtained. The analysis of CSS outcomes and risk factors were analyzed by Kaplan-Meier methods and multivariable Cox regression model. Results Both univariate and multivariate analyses showed that CSS significantly decreased with advanced ages(χ2=342.08, P<0.001). The OS(χ2=203.9, P<0.001)and CSS(χ2=160.5, P<0.001)of the young group were improved. In middle-aged group, hazard ratio(HR)was 1.177(95%CI: 1.068-1.296, P=0.001); in elderly group, HR was 1.643(95%CI: 1.495-1.807, P<0.001). Smaller age guaranteed a significantly improved CSS in patients who were at stages Ⅰ(P=0.015), Ⅲ(P<0.001), Ⅳ(P<0.001)or underwent non-surgical treatment(P<0.001). Conclusion Compared to older patients, the SCLC patients ≤49 years hold advantages in both OS and CSS. The prognostic value of age is more exact in patients at stage Ⅲ or managed non-operatively.

Key words: Small cell lung cancer, Young, Cancer specific survival, Surveillance, Epidemiology, and End Results

中图分类号:

R575.3

焦清华,周庆博,王燕,徐敏,陈慧玲,文洁. Ⅲ期小细胞肺癌年轻患者的肿瘤特异性生存优势[J]. 山东大学学报 (医学版), 2019, 57(12): 68-73.

JIAO Qinghua, ZHOU Qingbo, WANG Yan, XU Min, CHEN Huiling, WEN Jie. Tumor-specific survival advantage in young patients with stage Ⅲ small cell lung cancer[J]. Journal of Shandong University (Health Sciences), 2019, 57(12): 68-73.

参考文献

[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[2] Ong LT, Dunphy M, Foster A, et al. Prognostic value of preradiotherapy(18)F-FDG PET/CT volumetrics in limited-stage small-cell lung cancer[J]. Clin Lung Cancer, 2016, 17(3): 184-188.
[3] Xu K, Wang Y, Qi J, et al. Analysis of prognostic factors and clinical characteristics for patients with limited stage small cell lung cancer with pleural effusion[J]. Zhongguo Fei Ai Za Zhi, 2018, 21(1): 16-23.
[4] 刘沙,王明坤,张爽,等.血清LDH水平与局限期和广泛期小细胞肺癌预后的相关性研究[J]. 哈尔滨医科大学学报, 2015, 26(2): 158-161. LIU Sha, WANG Mingkun, ZHANG Shuang, et al. Correlation of lactate dehydrogenase with prognosis of limited and extensive disease stage small cell lung cancer[J]. Journal of Harbin Medical University, 2015, 26(2): 158-161.
[5] Foster NR, Mandrekar SJ, Schild SE, et al. Prognostic factors differ by tumor stage for small cell lung cancer: a pooled analysis of North Central Cancer Treatment Group trials[J]. Cancer, 2009, 115(12): 2721-2731.
[6] Janssen-Heijnen ML, Maas HA, Koning CC, et al. Tolerance and benefits of treatment for elderly patients with limited small-cell lung cancer[J]. J Geriatr Oncol, 2014, 5(1): 71-77.
[7] Sagman U, Maki E, Evans WK, et al. Small-cell carcinoma of the lung: derivation of a prognostic staging system[J]. J Clin Oncol, 1991, 9(9): 1639-1649.
[8] Sculier JP, Chansky K, Crowley JJ, et al. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th Edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition[J]. J Thorac Oncol, 2008, 3(5): 457-466.
[9] Paesmans M, Lafitte JJ, Lecomte J, et al. Validation and comparison of several published prognostic systems for patients with small cell lung cancer[J]. Eur Respir J, 2011, 38(3): 657-663.
[10] Nicholson SA, Beasley MB, Brambilla E, et al. Small cell lung carcinoma(SCLC): a clinicopathologic study of 100 cases with surgical specimens[J]. Am J Surg Pathol, 2002, 26(9): 1184-1197.
[11] Arnold BN, Thomas DC, Rosen JE, et al. Lung cancer in the very young: treatment and survival in the National Cancer Data Base[J]. J Thorac Oncol, 2016, 11(7): 1121-1131.
[12] Devesa SS, Bray F, Vizcaino AP, et al. International lung cancer trends by histologic type: male:female differences diminishing and adenocarcinoma rates rising[J]. Int J Cancer, 2005, 117(2): 294-299.
[13] Owonikoko TK, Ragin CC, Belani CP, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database[J]. J Clin Oncol, 2007, 25(35): 5570-5577.
[14] Bogart JA, Gajra A. Limited-stage small-cell lung cancer: an age limit for combined modality therapy?[J]. J Clin Oncol, 2015, 33(36): 4235-4237.
[15] 金波,刘云鹏.老年小细胞肺癌的治疗进展[J].中国医科大学学报, 2017, 46(8): 750-753. JIN Bo, LIU Yunpeng. Advances in treatments for small cell lung cancer in elderly patients[J]. Journal of China Medical University, 2017, 46(8): 750-753.
[16] Corso CD, Rutter CE, Park HS, et al. Role of chemoradiotherapy in elderly patients with limited-stage small-cell lung cancer[J]. J Clin Oncol, 2015, 33(36): 4240-4246.
[17] Jara C, Gómez-Aldaraví JL, Tirado R, et al. Small-cell lung cancer in the elderly-is age of patient a relevant factor?[J]. Acta Oncol, 1999, 38(6): 781-786.
[18] 田秀明,王玉祥,邱嵘,等.70岁及以上老年人Ⅲ期非小细胞肺癌三维适形放疗的预后因素[J].中华老年医学杂志, 2017, 36(9): 970-974. TIAN Xiuming, WANG Yuxiang, QIU Rong, et al. Prognostic factors of three-dimensional conformal radiotherapy for stage Ⅲ non-small cell lung cancer patients aged 70 and over [J]. Chinese Journal of Geriatrics, 2017, 36(9): 970-974.
[19] 陈传喜,袁红,杨志勇.吉西他滨与奥沙利铂联合三维适形同步放化疗治疗Ⅲ期非小细胞肺癌的临床观察[J].西部医学, 2014, 26(4): 442-444. CHEN Chuanxi, YUAN Hong, YANG Zhiyong. Gemcitabine with oxaliplatin chemotherapy plus three dimensional conformal radiotherapy for non-small cell lung cancer at stage Ⅲ[J]. Med J West China, 2014, 26(4): 442-444.
[20] 耿冲,叶涛,王强,等.放化疗顺序与局限性小细胞肺癌患者毒副反应关系的研究[J].中国基层医药, 2015, 22(11): 1679-1682. GENG Chong, YE Tao, WANG Qiang, et al. Research on the relationship of treatment toxicity with chemoradiotherapy order in limited-stage small cell lung cancer [J]. Chinese Journal of Primary Medicine and Pharmacy, 2015, 22(11): 1679-1682.
[21] Ludbrook JJ, Truong PT, MacNeil MV, et al. Do age and comorbidity impact treatment allocation and outcomes in limited stage small-cell lung cancer? A community-based population analysis[J]. Int J Radiat Oncol Biol Phys, 2003, 55(5): 1321-1330.
[22] Zhang W, Zhu H, Zhou Z, et al. [Prognostic value of AJCC TNM Staging 7th edition in limited-stage small cell lung cancer: validation in 437 patients] [J]. Zhonghua Zhong Liu Za Zhi, 2015, 37(12): 917-922.
[23] Nadpara PA, Madhavan SS, Tworek C, et al. Guideline-concordant lung cancer care and associated health outcomes among elderly patients in the United States[J]. J Geriatr Oncol, 2015, 6(2): 101-110.
[24] Subramaniam DS, Warner EA, Giaccone G. Ganetespib for small cell lung cancer[J]. Expert Opin Investig Drugs, 2017, 26(1): 103-108.
[25] Kalemkerian GP, Schneider BJ. Advances in small cell lung cancer[J]. Hematol Oncol Clin North Am, 2017, 31(1): 143-156.
[26] Salama JK, Pang H, Bogart JA, et al. Predictors of pulmonary toxicity in limited stage small cell lung cancer patients treated with induction chemotherapy followed by concurrent platinum-based chemotherapy and 70 Gy daily radiotherapy: CALGB 30904[J]. Lung Cancer, 2013, 82(3): 436-440.
[27] Hermes A, Waschki B, Gatzemeier U, et al. Analysis of treatment outcomes in two patient cohorts(2004-2005 and 2007-2008)with limited and extensive disease small-cell lung cancer[J]. Pneumologie, 2011, 65(4): 203-207.
[28] Slotman BJ, van Tinteren H, Praag JO, et al. Use of thoracic radiotherapy for extensive stage small-cell lung cancer: a phase 3 randomised controlled trial[J]. Lancet, 2015, 385(9962): 36-42.
[29] 臧婉娜,苏景伟,祝淑钗,等.局限期小细胞肺癌不同局部治疗方式的比较研究[J].中华放射医学与防护杂志, 2017, 37(1): 40-44. ZANG Wanna, SU Jingwei, ZHU Shuchai, et al. A comparative study of resection plus chemotherapy and chemoradiotherapy in limited-stage small cell lung cancer [J]. Chinese Journal of Radiological Medicine and Protection, 2017, 37(1): 40-44.
[30] Takenaka T, Takenoyama M, Inamasu E, et al. Role of surgical resection for patients with limited disease-small cell lung cancer[J]. Lung Cancer, 2015, 88(1): 52-56.

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