小细胞肺癌伴低钠血症的预后生存研究及临床特征分析

发布时间：2018-02-21 23:13

本文关键词： 小细胞肺癌低钠血症无进展生存期总生存期　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究不同时间点的血清钠水平是否均可以预测小细胞肺癌患者的预后;探讨小细胞肺癌患者临床特征与低钠血症的关系。方法:回顾性研究2009年9月~2015年9月期间我院肿瘤中心收治经病理组织学或细胞学证实的小细胞肺癌患者310例。根据初诊时及化疗期间最低血清钠水平分别将患者分为低钠组和正常组,研究低钠血症与性别、年龄、吸烟状态、ECOG评分、临床分期、化疗方案、上腔静脉综合征、脑转移等临床特征的相关性。通过病案系统或电话随访进展时间及死亡时间。采用SPSS19.0统计软件对数据进行统计学分析,两组间资料比较采用t检验或秩和检验,多组间资料比较采用方差分析或非参数检验,生存分析采用Kaplan-Meier法。P0.05有统计学意义。结果:1.310例SCLC患者中,初诊时合并低钠血症者50例,占16.13%,其中,中度和重度低钠血症者占低钠血症总人数的70%;一线化疗期间出现过低钠血症者共127例,占40.97%。2.初诊时低钠组与正常组相比,年龄、性别、吸烟状态、ECOG评分、临床分期、上腔静脉综合征、脑转移均无统计学意义(P0.05);化疗期间最低钠组与正常组相比,EP方案比EC方案更容易出现低钠血症(P=0.002),其他临床特征也无统计学意义(P0.05)。3.初诊时低钠组的中位PFS为7.63个月(95%CI为5.68~9.58个月),正常组的中位PFS为10.00个月(95%CI为8.98~11.02个月),比较显示差异有统计学意义(P=0.027);低钠组的中位OS为14.97个月(95%CI为13.54~16.39个月),正常组的中位OS为19.80个月(95%CI为18.65~20.95个月),比较显示差异也有统计学意义(P=0.005)。4.化疗期间最低钠组的中位PFS为8.73个月(95%CI为7.65~9.82个月),正常组的中位PFS为10.20个月(95%CI为8.86~11.54个月),两组比较有统计学意义(P=0.036);低钠组的中位OS为18.00个月(95%CI为14.35~21.66个月),正常组的中位OS为19.7个月(95%CI为18.37~21.03个月),两组的总生存情况比较结果显示差异无统计学意义(P=0.255)。结论:1.小细胞肺癌患者初诊时低钠血症的发生率为16.13%,化疗后低钠血症发生率明显增高。2.一线化疗期间,EP方案较EC方案更容易出现低钠血症。3.初诊时低钠血症是SCLC患者预后不良的独立危险因子;化疗期间最低钠水平与总生存期无明显相关性。
[Abstract]:Objective: to study whether serum sodium levels at different time points can predict the prognosis of patients with small cell lung cancer (SCLC). To investigate the relationship between clinical features and hyponatremia in patients with small cell lung cancer. Methods: a retrospective study of 310 patients with small cell lung cancer confirmed by histopathology or cytology from September 2009 to September 2015 in our tumor center. Patients were divided into hyponatremia group and normal group according to the lowest serum sodium level at first visit and during chemotherapy. To study hyponatremia and sex, age, smoking status and ECOG score, clinical stage, chemotherapy regimen, superior vena cava syndrome, The correlation of clinical features, such as brain metastasis, was analyzed by SPSS19.0 statistical software. T test or rank sum test was used to compare the data between the two groups. Analysis of variance or non-parametric test was used to compare the data among groups, and Kaplan-Meier method was used to analyze survival. Results among 1.310 patients with SCLC, 50 cases (16.13%) were diagnosed with hyponatremia at first visit. Patients with moderate and severe hyponatremia accounted for 70% of the total number of hyponatremia, 127 patients (40.97.2.) had hyponatremia during first-line chemotherapy. Age, sex, smoking status, ECOG score and clinical stage of hyponatremia group were compared with those of normal group. Superior vena cava syndrome, There was no significant difference in brain metastasis (P0.05A); during chemotherapy, hyponatremia was more likely to occur in the lowest sodium group than in the EC regimen, and no statistical significance was found in other clinical features. The median PFS of the hyponatremia group at first diagnosis was 7.63 months. The median PFS of normal group was 10.00 months, 95 CI was 8.98 ~ 11.02 months, the difference was statistically significant, the median OS of hyponatremia group was 14.97 months, 95 CI was 13.54 ~ 16.39 months, and the median OS of normal group was 19.80 months, 95 CI was 18.655-20.95 months, the mean OS of hyposodium group was 13.54 ~ 16.39 months, that of normal group was 19.80 months and that of normal group was 18.65 ~ 20.95 months, the mean OS of hyponatremia group was 14.97 months and 95 CI was 13.54 ~ 16.39 months, and that of normal group was 19.80 months and 18.6520.95 months, respectively. The median PFS of the lowest sodium group during chemotherapy was 8.73 months, 95 CI was 7.65 ~ 9.82 months, and the median PFS of the normal group was 10.20 months (8.86 ~ 11.54 months), which was significantly higher than that of the low sodium group (8.86 ~ 11.54 months). The mean OS of the normal group was 19.7 months and 95 CI was 18.37 ~ 21.03.Conclusion the incidence of hyponatremia in patients with small cell lung cancer is not significantly different from that of the two groups. The birth rate was 16.13 and the incidence of hyponatremia after chemotherapy was significantly increased .2. during first-line chemotherapy, hyponatremia was more likely to occur in EP regimen than in EC regimen. Hyponatremia was an independent risk factor for poor prognosis in patients with SCLC at first visit. There was no significant correlation between minimum sodium level and total survival during chemotherapy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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