Background: Malignant pleural effusion (PE) was generally defined as pleural effusion containing tumors with poor prognosis. Some kinds of undefined pleural effusions due to too small amount of effusion had poor prognosis too. This study aimed to analyze the clinical characteristics and prognostic factors of patients who suffered from limited-stage small cell lung cancer (LS-SCLC) complicated with pleural effusion.
Methods: A retrospective analysis included 542 patients who were diagnosed with LS-SCLC and had treatment in our hospital from October 2007 to January 2016. We had observed 109 patients who were diagnosed with pleural effusion at their first visit to the doctor. We analyzed the clinical characters, survival time and the prognostic factors of the 109 patients. Our main observation targets were overall survival (OS) and progression free survival (PFS).
Results: The median OS and PFS of whole group were 29.4 and 18.2 months. Before treatment, survival time of patients with PE were significantly shorter than patients without PE (median OS: 21.0 vs 31.7 months; median PFS: 14.1 vs 9.1 months; Log-rank, P=0.001, P=0.014). Multi-factor analysis of multivariate Cox shows PE was the independent prognostic factor of LS-SCLC (P=0.04). Single factor analysis showed factors affecting PE patient's survival time included clinical stages, lymph node (LN) stages, KPS scores, pulmonary atelectasis and the state of pleural after treatment. Cox multi-factor analysis reminded that the state of pleural effusion after treatment was the independent prognostic factor of LS-SCLC complicated with pleural effusion (P=0.016). There were three groups was apportioned patients without pleural effusion before treatment (group 1; n=433), patients whose pleural effusion disappeared after treatment (group 2; n=67) and patients whose pleural effusion didn't disappear after treatment (group 3; n=32).The median OS were 31.7, 23.2, 16.8 months in the group 1, 2, 3 and the median PFS were 19.1, 17.9, 11.4 months. Obvious difference was noted by the comparison of survival time of these three groups (Log-rank P<0.001, P<0.002). The difference between group 2 and group 3 was significant (Log-rank P=0.046, P=0.013) while no obvious difference was noted during comparison of group 1 and group 2. For patients who have LS-SCLC complicated with PE, there is no remarkable difference between chemoradiotherapy and chemotherapy alone.
Conclusions: The survival time of patients who suffered from limited-stage small cell lung cancer complicated with pleural effusion was obviously shortened. The disappearing of pleural effusion after treatment was the independent favorable prognostic factor of survival. How to treat needed further investigation.
背景与目的 一般将含有肿瘤细胞的胸水称为恶性胸水，预后差，因量少而无法定性胸水预后同样较差。本研究分析合并胸腔积液局限期小细胞肺癌患者的临床特点、预后因素。方法 回顾性分析了2007年10月-2016年1月期间于我院诊断为局限期小细胞肺癌542例患者，对其中初诊含有胸水患者109例的临床特点及生存时间、预后因素进行分析。主要观察指标为总生存期及无进展生存期。结果 全组患者中位总生存期、中位无进展生存期分别为29.4个月、18.2个月。治疗前合并胸水的患者较无胸水者生存期明显缩短（中位OS 21.0个月 vs 31.7个月，中位PFS 14.1个月 vs 19.1个月；Log-rank P=0.001, P=0.014），Cox多因素分析表明胸水是局限期小细胞肺癌的独立预后因素（P=0.004）；对于胸水患者，单因素分析提示影响OS的因素有临床分期、淋巴结分期、KPS评分、肺不张、治疗后胸水状态；而Cox多因素分析提示，治疗后胸水状态是合并胸水的局限期小细胞肺癌患者的独立预后因素（P=0.016）；患者初治无胸水（n=433）与经治后胸水消失（n=67）、胸水未消失（n=32）三组患者中位OS分别为31.7个月、23.2个月和16.8个月，中位PFS为19.1个月、17.9个月和11.4个月，三组生存期之间比较有明显差异（Log-rank, P<0.001, P<0.002），其中后两组差距明显（Log-rank, P=0.046, P=0.013），而前两组比较无明显差异（Log-rank, P=0.088, P=0.656）；对于胸水的患者，行放化疗治疗与单独化疗相比并无明显差距（Log-rank, P=0.243, P=0.390）。结论 合并胸水局限期小细胞肺癌生存期明显缩短，经治疗后胸水消失是生存的独立良好预后因素，如何治疗值得进一步探索。.
Keywords: Limited-stage; Pleural effusion; Prognosis; Small cell lung cancer.