小细胞肺癌合并恶性心包积液临床特点及预后因素分析

Analysis of prognostic factors and clinical characteristics of patients with small cell lung cancer with malignant pericardial effusion

摘要:

目的： 评估小细胞肺癌（small cell lung cancer，SCLC）患者恶性心包积液（malignant pericardial effusion，MPCE）的发生率及其预后的危险因素。方法： 回顾性分析美国监测、流行病学和最终结果（Surveillance，Epidemiology，and End Results，SEER）数据库中2004年至2015年SCLC患者的临床资料，采用Kaplan-Meier法及log-rank检验比较有无MPCE的总体生存率（overall survival，OS），Cox比例风险模型评估MPCE是否为影响预后的独立危险因素。随后采用单因素和多因素分析研究SCLC伴MPCE患者预后的独立相关因素。结果： 在74 125例SCLC患者中，1 694例（2.29%）出现MPCE。肿瘤较大且淋巴结分期较高的女性患者发生MPCE的概率较高。相比于没有MPCE组，MPCE患者的OS更差（中位生存时间：3个月vs.7个月；1年OS：16.50% vs.29.53%；2年OS：7.67% vs.13.19%；P<0.001）。多因素分析显示，MPCE也是SCLC预后较差的独立因素（HR=1.41，95% CI=1.34~1.48；P<0.001）。在1 694例SCLC伴MPCE中，多因素分析显示年龄、性别、N分期、放疗、化疗情况是患者预后的独立影响因素。结论： 伴有MPCE的SCLC患者少见（2.29%），总体生存率较低，诊断年龄较小、女性、N分期较低的患者预后较好，对患者进行放疗、化疗可以显著改善患者预后。

Abstract:

Objective: To evaluate the incidence of malignant pericardial effusion (MPCE) and its prognostic risk factors at presentation in patients with small-cell lung cancer (SCLC) . Methods: This study retrospectively analyzed the clinical data of SCLC patients from the SEER (Surveillance, Epidemiology, and End Results) database between 2004 and 2015. The Kaplan-Meier method and log-rank test were used to estimate the overall survival (OS) and the Cox proportional hazard model was used to assess whether MPCE was an independent risk factor for prognosis. Then we used univariate and multivariate analyses to explore the independent prognostic factors of SCLC with MPCE. Results: Among the 74 125 patients with SCLC, MPCE was present in 1 694 (2.29%) cases. The probability of MPCE was higher in female patients with larger tumors and higher lymph node stages at presentation. Compared with patients without MPCE, the OS in patients with MPCE was significantly worse (median survival time: 3 months vs.7 months; estimated 1-year OS: 16.50% vs. 29.53%; 2-year OS: 7.67% vs.13.19%; P<0.001) . Multivariate analysis showed MPCE was also an independent factor for poor prognosis of SCLC (HR=1.41, 95% CI=1.34-1.48; P<0.001) . In 1 694 cases of SCLC with MPCE, multivariate analysis showed that age, gender, N stage, radiotherapy and chemotherapy were independent prognostic factors. Conclusion: SCLC patients with MPCE are rare (2.29%) with poor OS, and the patients with younger age at diagnosis, female and lower N stage have a better prognosis. Radiotherapy and chemotherapy can significantly improve the prognosis of the patients.