Prognositc factor analysis for lung cancer patientswith superior vena cava syndrome treated withradiation therapy

肺癌合併上腔靜脈症候群接受放射治療之預後因子分析

楊英傑(Ying-Chieh Yang) ； 詹建勝(Jian-Sheng Jan) ； 林進清(Jin-Ching Lin)

《放射治療與腫瘤學》 14卷2期 (2007/06) Pp. 95-103

https://doi.org/10.6316/TRO/200714(2)95

摘要

目的：上腔靜脈症候群（SVC syndrome）百分之九十由惡性腫瘤所引起。而其中最常見的原發腫瘤是肺癌。在這個回顧性研究中，我們探討了姑息性放射治療對肺癌病患併發之上腔靜脈症候群的治療效果以及預後因子。
材料與方法：從 1996 年 1 月到 2003 年 12 月，我們接受了 92 位原發性肺癌合併上腔靜脈症候群的病患的會診而進行放射治療。我們回顧了所有病歷以及放射治療紀錄。所有的病人都追蹤到其死亡。我們運用 Kaplan-Meier 存活曲線以及 log-rank test 比較各因子對存活的影響。
結果：九十二位病人中有 53 位完成當初所計劃的 30 葛雷照射。所有病患的中位存活期為 65天。無遠端轉移病患相較於遠端轉移病患有較長的中位存活期（150 vs. 49 天， p = 0.0038）。完成當初所計劃的 30 葛雷照射之病患相較於無法完成照射之病患有較長的中位存活期（111 vs. 14天， p= 0.0006）。Karnofsky 指數在百分之七十以上的病患相較於低於七十的病患有較長的中位存活期（107 vs. 44 天，p = 0.0089）。治療後有減輕症狀的病患相較於沒有減輕或加重症狀的病
患有較長的中位存活期（113 vs. 15 天，p = 0.0000）。而多變異分析顯示無遠端轉移為顯著影響存活的預後因子（p = 0.019）。
結論：我們的分析顯示：沒有遠端轉移，Karnofsky 指數高於或等於 70%，治療後症狀減輕，完成當初計劃的療程，這四個都是肺癌合併上腔靜脈症候群接受放射線治療的病患之正面預後因素。

並列摘要

Purpose : Superior vena cava (SVC) syndrome is associated with malignancy in more than 90% of cases. Among them, lung cancers are the most common primary tumor.
The aim of this retrospective study was to investigate prognostic factors in lung cancer patients with SVC syndrome treated with palliative radiation therapy (RT).
Materials and Methods : From January 1996 to December 2003, 92 lung cancer patients with SVC syndrome were referred for RT. Clinical charts and RT records were reviewed. All patients were followed up until death. Kaplan-Meier survival curves were
calculated and comparisons of different subgroups were made by the log-rank test.
Results : Fifty-three of 92 patients completed the planned RT (30 Gy). The median overall survival for all patients was 65 days. Patients without distant metastasis at RT had significantly longer median survival than those with distant metastasis at RT (150 vs. 49 days, p = 0.0038). Patients receiving complete RT had significantly longer median survival than those who received incomplete RT (111 vs. 14 days, p= 0.0006).
Patients with Karnofsky performance scale ＞= 70% had significantly longer median survival than those with Karnofsky performance scale ＜70% (107 vs. 44 days, p = 0.0089). Patients with symptom relief after RT had significantly longer median survival than those without symptom relief (113 vs. 15 days, p = 0.0000). With multivariate analysis, only distant metastasis was a significant prognostic factor (p = 0.019).
Conclusion : Our analysis showed that no distant metastasis at RT, Karnofsky performance scale ＞= 70%, symptom relief after RT, and RT completion were significant favorable prognostic factors for lung cancer patients with SVC syndrome who receivedRT.