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目的:探讨大细胞肺癌(1arge cell lung cancer,LCLC)患者的预后影响因素及术后不同治疗方式的疗效差异。方法:回顾性分析2000年1月至2009年12月行手术治疗的80例LCLC患者的临床资料,采用单因素和多因素方法分析预后的影响因素及术后不同治疗方式的临床疗效。结果:80例LCLC患者术后临床分期:Ⅰ期21例,Ⅱ期22例,Ⅲ期28例,Ⅳ期9例。29例患者术后未行任何全身治疗,35例行单纯化疗,5例行IFN-α联合化疗,11例行细胞因子诱导的杀伤细胞(cytokine-induced killercell,CIK)联合化疗。80例LCLC患者1、3、5年生存率分别为72.5%、45.6%、31.0%。单因素分析显示,N分期(P=0.002)、M分期(P<0.001)、临床分期(P<0.001)、手术方式(P=0.001)、术后不同治疗(P<0.001)与患者预后相关。多因素分析显示,临床分期(P<0.001)、手术方式(P=O.034)、术后不同治疗(P=0.001)是LCLC患者预后的独立影响因素。通过对不同治疗方式组的生存期进行分析,单纯化疗组、CIK联合化疗组与无治疗组的生存期差异均具有统计学意义(均P<0.05)。对43例Ⅰ/Ⅱ期LCLC患者进行分析后发现,CIK联合化疗组分别与无治疗组、单纯化疗组之间生存期差异具有统计学意义(P=0.004.0.044);对37例Ⅲ/Ⅳ期患者的生存期进行分析后发现,单纯化疗组、以CIK联合化疗组、IFN-α联合化疗组患者生存与无治疗组患者生存差异均具有统计学意义(P=0.012、0.041、0.011)。结论:影响LCLC患者预后的独立因素是临床分期、手术方式、术后治疗方式;早晚期LCLC患者接受术后治疗均可获益,且CIK联合化疗组疗效优于单纯化疗组。
Objective: To investigate the influencing factors of prognosis in patients with large cell lung cancer (LCLC) and the effect of different treatment methods after operation. Methods: The clinical data of 80 patients with LCLC underwent surgical treatment from January 2000 to December 2009 were retrospectively analyzed. The influencing factors of prognosis and the clinical effect of different treatment methods were analyzed by single factor and multifactorial methods. Results: The clinical staging of 80 patients with LCLC was stage Ⅰ in 21 cases, stage Ⅱ in 22 cases, stage Ⅲ in 28 cases and stage Ⅳ in 9 cases. Twenty-nine patients underwent no systemic therapy after surgery, 35 received chemotherapy alone, 5 received IFN-α combined with chemotherapy and 11 received cytokine-induced killer cell (CIK) combined with chemotherapy. The 1, 3, 5-year survival rates of 80 LCLC patients were 72.5%, 45.6% and 31.0%, respectively. Univariate analysis showed that the prognosis of patients with N stage (P = 0.002), M stage (P <0.001), clinical stage (P <0.001), operation mode . Multivariate analysis showed that clinical stage (P <0.001), surgical approach (P = 0.034), postoperative different treatment (P = 0.001) were independent prognostic factors in patients with LCLC. Through the analysis of survival time of different treatment groups, there were significant differences in survival between chemotherapy group, CIK combined chemotherapy group and no treatment group (all P <0.05). Analysis of 43 patients with stage I / II LCLC showed that there was significant difference in survival between CIK combined chemotherapy group and no treatment group and chemotherapy alone group (P = 0.004.0.044) Survival analysis of patients with period of chemotherapy showed that there were significant differences in survival between chemotherapy group and CIK combined chemotherapy group and IFN-α combined chemotherapy group (P = 0.012,0.041,0.011). Conclusion: The independent factors influencing the prognosis of patients with LCLC are the clinical staging, operation method and postoperative treatment. Early and late LCLC patients can benefit from postoperative treatment, and CIK combined chemotherapy group is superior to chemotherapy alone group.