性别、组织学和诊断时间是预后的重要因素：对日本 1499 例晚期非小细胞肺癌从不吸烟患者的分析。

Gender, histology, and time of diagnosis are important factors for prognosis: analysis of 1499 never-smokers with advanced non-small cell lung cancer in Japan.

机构信息

National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan. t-kawaguchi@

出版信息

J Thorac Oncol. 2010 Jul;5(7):1011-7. doi: 10.1097/JTO.0b013e3181dc213e.

DOI:10.1097/JTO.0b013e3181dc213e

PMID:20502360

Abstract

BACKGROUND

There has been a growing interest in lung cancer in never-smokers.

METHODS

Utilizing a database from the National Hospital Study Group for Lung Cancer, information for never-smokers and ever-smokers with advanced non-small cell lung cancer was obtained from 1990 to 2005, including clinicopathologic characteristics, chemotherapy response, and survival data. Time of diagnosis was classified into two periods: 1990-1999 and 2000-2005. Multivariate analysis was performed using the Cox regression and logistic regression method, including gender, age, performance status, histology, stage, and period of diagnosis.

RESULTS

There were 1499 never-smokers and 3455 ever-smokers with advanced stage IIIB and IV diseases who received cytotoxic chemotherapy. Never-smokers generally included more females, were younger, with better performance status and more adenocarcinoma diagnosed (p < 0.0001 for all). Smoking status was a significant prognostic factor (never-smoker versus ever-smoker; hazard ratio [HR] = 0.880, 95% confidence interval [CI]: 0.797-0.970; p = 0.0105). In separate multivariate analysis for never-smokers and ever-smokers, female gender and better performance status (p < 0.0001 for both) were both favorable prognostic factors. However, adenocarcinoma histology (versus squamous cell carcinoma; HR = 0.790, 95% CI: 0.630-0.990; p = 0.0403) and the period after 2000 (versus before 2000; HR = 0.846, 95% CI: 0.731-0.980; p = 0.0254) were significant only in the never-smokers, and younger age (HR = 1.007, 95% CI: 1.003-1.011; p = 0.0010) was significant only in the ever-smokers. In an exploratory analysis, different profiles were observed in predictive factors for chemotherapy response between the two groups.

CONCLUSIONS

Never-smokers with non-small cell lung cancer lived longer than ever-smokers. Gender, histology, and time of diagnosis are important factors for prognosis in these patients.

摘要

背景

非吸烟人群的肺癌越来越受到关注。

方法

利用国家医院肺癌研究组的数据库，我们从 1990 年至 2005 年获得了从不吸烟和曾经吸烟的晚期非小细胞肺癌患者的信息，包括临床病理特征、化疗反应和生存数据。诊断时间分为两个时期：1990-1999 年和 2000-2005 年。使用 Cox 回归和逻辑回归方法进行多变量分析，包括性别、年龄、表现状态、组织学、分期和诊断时期。

结果

共有 1499 名从不吸烟和 3455 名曾经吸烟的晚期 IIIB 和 IV 期患者接受了细胞毒性化疗。从不吸烟者通常包括更多的女性，年龄更小，表现状态更好，并且更多地诊断出腺癌（所有 p<0.0001）。吸烟状况是一个显著的预后因素（从不吸烟者与曾经吸烟者；风险比[HR] = 0.880，95%置信区间[CI]：0.797-0.970；p = 0.0105）。在对从不吸烟者和曾经吸烟者的单独多变量分析中，女性和更好的表现状态（均为 p<0.0001）都是有利的预后因素。然而，腺癌组织学（与鳞状细胞癌相比；HR = 0.790，95%CI：0.630-0.990；p = 0.0403）和 2000 年后的时期（与 2000 年前相比；HR = 0.846，95%CI：0.731-0.980；p = 0.0254）仅在从不吸烟者中具有统计学意义，而年龄较小（HR = 1.007，95%CI：1.003-1.011；p = 0.0010）仅在曾经吸烟者中具有统计学意义。在探索性分析中，我们观察到两组患者化疗反应的预测因素存在不同的特征。