摘要目的:探讨不可切除肺鳞癌的预后影响因素。方法:纳入2005年1月至2018年6月就诊于中国医科大学附属第一医院、不能手术切除的局部晚期或复发转移(Ⅲa～Ⅳ期)肺鳞癌患者350例，收集患者的临床病理资料和生存资料，采用Kaplan-Meier法进行生存分析，采用单因素分析和多因素Cox回归分析明确预后独立影响因素。结果:350例肺鳞癌患者的中位生存时间为16.7个月。单因素分析结果显示，临床分期、美国东部肿瘤协作组(ECOG)评分、化疗线数、化疗疗效、是否放疗、化疗前C反应蛋白(CRP)、乳酸脱氢酶(LDH)、癌胚抗原(CEA)、癌抗原125(CA125)、是否骨转移、是否脑转移和是否肝转移与晚期肺鳞癌患者的预后有关(均 P<0.05)。Cox多因素分析显示，ECOG评分( HR＝1.855，95% CI为1.063～3.239, P＝0.030)、既往是否行肺切除术( HR＝0.476，95% CI为0.302～0.751， P＝0.001)、一线化疗疗效(疾病稳定： HR＝0.293，95% CI为0.159～0.540， P<0.001；完全缓解+部分缓解： HR＝0.223，95% CI为0.120～0.413， P<0.001)、化疗前CRP( HR＝1.715，95% CI为1.080～2.723， P＝0.042)、LDH( HR＝1.116，95% CI为0.780～1.596， P＝0.002)、CEA( HR＝1.855，95% CI为1.361～2.528, P<0.001)、是否肝转移( HR＝2.453, 95% CI为1.461～4.120, P＝0.001)是不可切除肺鳞癌患者的独立预后影响影响因素。 结论:ECOG评分、既往是否行肺切除术、一线化疗疗效、化疗前CRP、LDH及CEA水平、是否发生肝转移是晚期不可手术肺鳞癌患者的独立预后影响因素。

abstractsObjective:To investigate the prognostic factors associated with unresectable (stage Ⅲa-Ⅳ, according to the 7th edition of the AJCC cancer staging manual) lung squamous cell carcinoma.Methods:We retrospectively analyzed 350 patients with inoperable locally advanced, recurrent or metastatic lung squamous cell carcinoma who were admitted to the First Affiliated Hospital of Chinese Medical University from January 2005 to June 2018. The clinical pathological data, treatment and survival follow-up information of the patients were collected. Kaplan-Meier survival was used to compare the overall survival rate of different risk groups. Univariate analysis and multivariate Cox regression analysis were used to determine the independent prognostic factors.Results:A total of 350 patients were enrolled. The median overall survival (OS) of these patients was 16.7 months. Univariate analysis showed the stage, Eastern Cooperative Oncology Group(ECOG), first-line chemotherapy evaluation (RECIST version 1.1), radiation therapy, number of systemic chemotherapy lines, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), C reactive protein (CRP), lactate dehydrogenase (LDH), whether liver, brain, boneor metastasis were associated with the OS of patients with advanced lung squamous cell carcinoma (all P<0.05). Multivariate analysis showed that ECOG score ( HR=1.855, 95% CI: 1.063-3.239, P=0.030), whether underwent lung resection ( HR=0.476, 95% CI: 0.302-0.751, P=0.001), first-line chemotherapy evaluation [stable disease (SD): HR=0.293, 95% CI: 0.159-0.540, P<0.001; complete response (CR)+ partial response (PR): HR=0.223, 95% CI: 0.120-0.413, P<0.001], CRP ( HR=1.715, 95% CI: 1.080-2.723, P=0.042), LDH ( HR=1.116, 95% CI: 0.780-1.596, P=0.002) and CEA ( HR=1.855, 95% CI: 1.361-2.528, P<0.001) before chemotherapy, liver metastasis ( HR=2.453, 95% CI: 1.461-4.120, P=0.001) are independent prognostic factors for patients with unresectable lung squamous cell carcinoma. Conclusion:The ECOG score, surgical treatment history, first-line chemotherapy, LDH, CEA and CRP before chemotherapy, liver metastasis are independent prognostic factors for patients with advanced lung squamous cell carcinoma.