C-反应蛋白和吸烟对晚期非小细胞肺癌使用姑息性一线化疗预后判断的意义
2010/01/07
目的：分析是否C反应蛋白(CRP) 和吸烟状态能够为晚期非小细胞肺癌(NSCLC)接受姑息性一线化疗的患者提供预后判断的信息。
方法：回归性分析在2002年1月1日～2007年1月31日非小细胞肺癌IIIB/IV期以及世界卫生组织体力状态（PS）评分0-2分的患者的病案信息。使用Cox’s比例风险模型识别预后的预测因子。
结果：共计入选评价了289例连续患者。 68%的患者处在疾病IV期，67%的患者PS评分为0或1分。中位数生存期为7.4个月。在化疗开始时，206名患者（71%）的CRP值升高(>=10 mg/l).144名患者（50%）为现时吸烟者。进行单变量分析，具有升高的CRP值的患者生存率降低 (风险比 [HR] = 1.67, 95%可信区间 [CI], 1.28-2.19, p < 0.001).治疗开始时吸烟与生存率缩短是相关的 (HR 1.56, 95% CI, 1.22-1.98, p < 0.001).一直吸烟者与从不吸烟者相比生存率缩短 (HR 1.80, 95% CI, 1.25-2.59, p = 0.001). 以疾病分期、PS评分、白蛋白和性别作为协变量进行多变量分析发现，在化疗开始时吸烟和CRP升高都是生存率的独立负性预测因子。
结论：C-反应蛋白和吸烟状态是晚期非小细胞肺癌使用姑息性一线化疗的患者生存的独立预测因子并能够为已有的预测因子如疾病分期和体力状态提供补充性信息。
（张永明编译 刘国梁审校）
Journal of Thoracic Oncology. 4(3):326-332, March 2009.
Prognostic Significance of C-Reactive Protein and Smoking in Patients with Advanced Non-small Cell Lung Cancer Treated with First-Line Palliative Chemotherapy.
Koch, Andrea MD *+++; Fohlin, Helena MSc [S]; Sorenson, Sverre MD, PhD +++[//]
*Allergy Centre, University Hospital; Linkoping; +Department of Medical and Health Sciences, Linkoping University; ++Department of Pulmonary Medicine, University Hospital, Linkoping; [S]Oncologic Centre, University Hospital, Linkoping; and [//]Department of Medicine, County Hospital, Jonkoping, Sweden.
Hypothesis: The objective of the study was to analyze if C-reactive protein (CRP) and smoking status provide prognostic information in patients with advanced non-small cell lung cancer (NSCLC) receiving palliative first-line chemotherapy.
Methods: Retrospective, single-institutional study, comprising all patients with NSCLC stage IIIB/IV and World Health Organization performance status (PS) 0-2 who started palliative first-line chemotherapy between January 1, 2002, and January 31, 2007. Patient records were reviewed. Cox’s proportional hazards model was used to identify prognostic factors.
Results: Two hundred eight-nine consecutive patients were evaluable. Sixty-eight percent had stage IV disease and 67% had PS 0 or 1. Median survival was 7.4 months. At onset of chemotherapy, 206 patients (71%) had elevated CRP values (>=10 mg/liter). One-hundred-forty-four patients (50%) were current smokers. On univariate analysis, patients with elevated CRP levels had inferior survival (hazard ratio [HR] = 1.67, 95% confidence interval [CI], 1.28-2.19, p < 0.001). Smoking at onset of treatment was associated with shorter survival (HR 1.56, 95% CI, 1.22-1.98, p < 0.001). Ever smokers had shorter survival than never smokers (HR 1.80, 95% CI, 1.25-2.59, p = 0.001). On multivariate analysis, with stage, PS, albumin, and gender as covariates, both smoking at start of chemotherapy and CRP elevation were independent negative prognostic factors for survival.、
Conclusions: CRP and smoking status are independent prognostic factors for survival in patients with advanced NSCLC receiving palliative first-line chemotherapy and provide additional information to established prognostic factors such as stage of disease and performance status.
Accession Number 01243894-200903000-00012.
DOI Number 10.1097/JTO.0b013e31819578c8
方法：回归性分析在2002年1月1日～2007年1月31日非小细胞肺癌IIIB/IV期以及世界卫生组织体力状态（PS）评分0-2分的患者的病案信息。使用Cox’s比例风险模型识别预后的预测因子。
结果：共计入选评价了289例连续患者。 68%的患者处在疾病IV期，67%的患者PS评分为0或1分。中位数生存期为7.4个月。在化疗开始时，206名患者（71%）的CRP值升高(>=10 mg/l).144名患者（50%）为现时吸烟者。进行单变量分析，具有升高的CRP值的患者生存率降低 (风险比 [HR] = 1.67, 95%可信区间 [CI], 1.28-2.19, p < 0.001).治疗开始时吸烟与生存率缩短是相关的 (HR 1.56, 95% CI, 1.22-1.98, p < 0.001).一直吸烟者与从不吸烟者相比生存率缩短 (HR 1.80, 95% CI, 1.25-2.59, p = 0.001). 以疾病分期、PS评分、白蛋白和性别作为协变量进行多变量分析发现，在化疗开始时吸烟和CRP升高都是生存率的独立负性预测因子。
结论：C-反应蛋白和吸烟状态是晚期非小细胞肺癌使用姑息性一线化疗的患者生存的独立预测因子并能够为已有的预测因子如疾病分期和体力状态提供补充性信息。
（张永明编译 刘国梁审校）
Journal of Thoracic Oncology. 4(3):326-332, March 2009.
Prognostic Significance of C-Reactive Protein and Smoking in Patients with Advanced Non-small Cell Lung Cancer Treated with First-Line Palliative Chemotherapy.
Koch, Andrea MD *+++; Fohlin, Helena MSc [S]; Sorenson, Sverre MD, PhD +++[//]
*Allergy Centre, University Hospital; Linkoping; +Department of Medical and Health Sciences, Linkoping University; ++Department of Pulmonary Medicine, University Hospital, Linkoping; [S]Oncologic Centre, University Hospital, Linkoping; and [//]Department of Medicine, County Hospital, Jonkoping, Sweden.
Hypothesis: The objective of the study was to analyze if C-reactive protein (CRP) and smoking status provide prognostic information in patients with advanced non-small cell lung cancer (NSCLC) receiving palliative first-line chemotherapy.
Methods: Retrospective, single-institutional study, comprising all patients with NSCLC stage IIIB/IV and World Health Organization performance status (PS) 0-2 who started palliative first-line chemotherapy between January 1, 2002, and January 31, 2007. Patient records were reviewed. Cox’s proportional hazards model was used to identify prognostic factors.
Results: Two hundred eight-nine consecutive patients were evaluable. Sixty-eight percent had stage IV disease and 67% had PS 0 or 1. Median survival was 7.4 months. At onset of chemotherapy, 206 patients (71%) had elevated CRP values (>=10 mg/liter). One-hundred-forty-four patients (50%) were current smokers. On univariate analysis, patients with elevated CRP levels had inferior survival (hazard ratio [HR] = 1.67, 95% confidence interval [CI], 1.28-2.19, p < 0.001). Smoking at onset of treatment was associated with shorter survival (HR 1.56, 95% CI, 1.22-1.98, p < 0.001). Ever smokers had shorter survival than never smokers (HR 1.80, 95% CI, 1.25-2.59, p = 0.001). On multivariate analysis, with stage, PS, albumin, and gender as covariates, both smoking at start of chemotherapy and CRP elevation were independent negative prognostic factors for survival.、
Conclusions: CRP and smoking status are independent prognostic factors for survival in patients with advanced NSCLC receiving palliative first-line chemotherapy and provide additional information to established prognostic factors such as stage of disease and performance status.
Accession Number 01243894-200903000-00012.
DOI Number 10.1097/JTO.0b013e31819578c8
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吸烟和胰腺癌的关系的病例回顾：观察性研究的质量是否影响荟萃分析的结果？
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吸烟特征对泌尿道癌症风险的影响：一个流行病学研究的荟萃分析
