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关键词：肺肿瘤/诊断；存活率分析；比例危险度模型
摘要 目的 应用Cox比例危险度模型，对影响老年人肺癌治疗后生存的可能因素进行多因素分析，并确立治疗后生存预测模型。 方法 对313例老年人原发肺癌初治患者进行了随访，观察17个指标与老年人肺癌长期生存的关系。采用单因素和多因素分析、拟合曲线分析及残差图检验。 结果 多因素分析结果显示5个明显影响老年人肺癌预后的因素，其作用强度依次为身体状况、近期疗效、临床分期、年龄和治疗方法。据此计算了每个患者的预后指数(PV)，根据其大小将患者分成5个危险组，结果显示随着PV的升高生存率逐步下降。
结论 影响老年人肺癌治疗后生存率的主要因素是身体状况、近期疗效、临床分期、年龄和治疗方法；且随着PV的升高，其生存率逐步下降。
A study on factorsinfluencing survival of senile patients with lung cancer by Cox's proportional hazardmodel
Wu Shengqi, Hou Yuanshu. Hunan Tumor Hospital, Changsha 410006
Abstract Objective To analysemultivariately the possible factors influencing survival of the senile patients with lungcancer, and to establish models for predicting survival by Cox's proportional hazardmodel. Methods A prospective follow-up study of 313 senile lung cancer patientswas undertaken from 1 January 1987 to 31 December 1991. Seventeen factors which mightinfluence long term survival were studied by univariate analysis (Kruskal-Walli's test forKaplan-Meier survival curve) and by multivariate analysis (Cox's proportional hazardmodel). The goodness fit of estimated predicting models of survival were checked byfitting curve and residual plot. Results Multivariate analysis using Cox's model revealed 5 significantlyprognostic factors: body status, short-term response to treatment , clinical stage, ageand method of treatment. According to their regression coefficients, the predicting value(PV) of each patient was calculated, then all patients were divided into five riskgroups according to PV, their predicting models of survival rates were established ingroups, the survival rate of lung cancer patients decrease with the rise of PV. Conclusions Theseresults suggest that the body status, short-term response to treatment, clinical stage,age and method of treatment are the major factors affecting prognosis. The survivalprobability of lung cancer patients decreases with the rise of PV.
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