摘要目的 探讨放射治疗在老年Ⅲ期非小细胞肺癌(NSCLC)中的临床价值及其预后因素.方法 2007-2012年226例接受放射治疗为主的老年Ⅲ期NSCLC纳入回顾分析.中位年龄71岁(65～88岁).120例接受三维适形放疗,106例接受二维放疗.中位总剂量60 Gy(24～74 Gy).临床因素包括年龄、性别、Kamofsky评分(KPS)、简化并发症评分(SCS)、病理类型、临床分期、T分期、N分期、治疗前血红蛋白、肿瘤位置、治疗方案、放疗技术及放疗总剂量.研究指标为总生存率(OS)和癌症专项生存率(CSS).Kaplan-Meier法和Log-rank法比较生存率,Cox回归分析法进行多因素分析.结果 全组1、3、5年OS分别为60.7％、12.4％、5.3％,中位生存时间为14.9个月.1、3、5年CSS分别为67.6％、17.4％、9.9％.多因素分析结果显示,三维放疗(OS:HR=1.427,95％CI:1.070～1.902,P=0.015;CSS:HR=1.427,95％CI;1.092～2.073,P=0.012)、KPS评分≥80分(OS:HR=1.538,95％ CI:1.102～2.148,P=0.011;CSS:HR=1.575,95％ CI:1.086～2.283,P =0.017)、放疗总剂量≥60 Gy(OS:HR=0.579,95％CI:0.418～0.801,P=0.001;CSS:HR=0.621,95％CI:0.431～0.895,P=0.011)是提高OS和CSS的独立影响因素,而SCS≤7分(OS:HR=1.383,95％CI:1.035～1.847,P=0.028)是提高OS的独立影响因素,而与CSS的提高无关.结论 放射治疗是老年Ⅲ期非小细胞肺癌的有效治疗手段,尤其对于一般状态较好的老年患者,予以三维放疗60 Gy以上剂量,能够取得更好的预后.

abstractsObjective To investigate the clinical value of radiotherapy in elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) and its prognostic factors.Methods Totally 226 patients with stage Ⅲ NSCLC,aged 65 years or more,who received radiotherapy from 2007 to 2002 were enrolled in this retrospective study.The median age was 71 years (ranged 65 to 88 years).120 patients received three-dimensional radiotherapy (3D),and 106 patients received two-dimensional radiotherapy (2D).The median total dose was 60 Gy (ranged 24 to 74 Gy).Clinical factors were reviewed,including age,gender,Karnofsky performance status (KPS),the simplified comorbidity status (SCS),pathology type,clinical stage,tumor stage,lympha node stage,pretreatment hemoglobin (Hb),tumor location,treatment scheme,radiotherapy technology and radiation dose.The observed indexes were overall survival (OS) and cancer specific survival (CSS).Survival distributions were assessed and compared by using the methods of Kaplan-Meier and log-rank test.Multivariate analyses were conducted by using Cox regression models.Results The 1-,3-,5-year OS were 60.7％,12.4％,5.3％,respectively,and the median survival time was 14.9 months for the whole group.The 1-,3-,5-year CSS were 67.6％,17.4％,9.9％,respectively.The multivariate analysis showed that 3D radiotherapy (OS:HR=1.427,95％CI:1.070-1.902,P=0.015;CSS:HR=1.427,95％CI:1.092-2.073,P=0.012),KPS≥80 (OS:HR=1.538,95％CI:1.102-2.148,P=0.011;CSS:HR =1.575,95％CI:1.086-2.283,P=0.017) and total dose≥60 Gy (OS:HR=0.579,95％CI:0.418-0.801,P=0.001;CSS:HR=0.621,95％CI:0.431-0.895,P=0.011) were the independent influencing factors for improving OS and CSS,while SCS≤7 (OS:HR=1.383,95％CI:1.035-1.847,P=0.028) was the independent influencing factor for improving OS but not for improving CSS.Conclusions Radiotherapy is an effective treatment for elderly patients with stage Ⅲ NSCLC.3D radiotherapy with a total dose of at least 60 Gy can improve the prognosis,especially for elderly patients with good physical condition.