2011-2015单中心新诊断肺癌临床特点及变化趋势分析

发布时间：2018-02-09 13:42

本文关键词： 肺癌中国临床特点　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:肺癌已成为我国发病率最高的癌症,死亡率也居各类肿瘤之首。2015年,我国新增肺癌患者733300例,死亡610200例。迄今我国对肺癌患者的临床信息登记并不完善细致,这也导致我国肺癌患者的相关临床信息,包括:组织病理学构成、各分期患者比例、抽烟情况、基因突变情况等并不清晰。另一方面,我国肺癌患者的死亡率也高于世界平均水平,这与早期发现早期诊断不足有关,约2/3患者确诊时已是进展期。过去5年来,随着医疗保险在我国,尤其东部沿海地区的普及,越来越多的患者得以早期诊断和治疗。早诊患者的增多是否带来不同亚群构成的变化尚不清楚。目的:本研究以我国东部一大型综合性医院收治的肺癌患者为对象,旨在分析近5年来(2011-2015)新诊断肺癌患者的相关临床特征及变化趋势,从而对我国肺癌患者的临床特征和变化趋势有一个较为详细的了解。方法:回顾性研究2011年1月-2015年12月期间在浙江大学医学院附属第二医院首诊为肺癌的病例,所有患者均经肺部组织病理活检或细胞学或外科手术切除组织病理检测确诊。患者临床信息、影像资料通过医院信息管理系统(HIS)获得。肺癌诊断分期原则以第7版TNM肿瘤分期标准为依据。数据整理收集后通过spass 20.0进行统计分析。结果:2011-2015年间,本院新诊断肺癌共5779例,其中男性3719例,平均年龄62.7岁;女性2060例,平均年龄59.7岁。各种不同病理类型的构成比如下:腺癌60.0%,鳞癌25.6%,小细胞肺癌8.5%,大细胞肺癌0.6%,腺鳞癌1%,其他非小细胞肺癌1.6%,不能明确分类的病理类型2.8%。女性中腺癌比例(86.9%)明显高于男性(45.1%)。过去5年中,无相关呼吸系统症状而因体检发现确诊的患者比例逐年升高,从21.6%升至27.5%;与此同时腺癌患者比例呈逐渐上升趋势(从54.1%升至62.5%),鳞癌比例却逐渐下降(从31.8%降至23.4%),小细胞肺癌所占比例变化不大。因呼吸道及肺部症状就诊而确诊的肺癌患者中,晚期肺癌(TNM分期ⅢB-Ⅳ期)的比例达50.7%,远高于因体检发现而确诊的患者(21.4%),而早期(0-Ⅰ期)比例则显著低于后者(20.3%vs56.6%)。确诊的肺癌患者中,男性有吸烟史的比例占80.2%,而女性有吸烟史的仅占2.7%。509例患者,包括440腺癌,61例鳞癌和8例腺鳞癌患者接受了 EGFR基因突变检测,结果显示:女性腺癌患者中EGFR基因突变率达66%,Exon21 L858R和Exon19 DEL是最常见突变类型,占91%;男性腺癌患者EGFR基因突变率37%,Exon21L858R和Exon19DEL占88%。61例鳞癌患者中,仅一例患者Exon20 S768I突变。8例腺鳞癌患者中6例患者EGFR突变阳性。结论:本研究从多方面对肺癌患者的临床特点进行分析阐述,包括:年龄分布、性别、吸烟史、病理分型、组织学构成、肿瘤分期、基因突变检测等,得出结论如下:(1)在肺癌各病理亚型中,腺癌为最常见类型,女性中腺癌比例更是高达86.9%,这可能与我国女性患者的吸烟率低有关。(2)过去5年中,因体检发现得以确诊的患者比例逐年升高,这部分患者中腺癌比例达84%,而因呼吸系统相关症状就诊确诊的肺癌患者中腺癌比例仅55%。(3)过去5年中,腺癌患者比例呈逐渐上升趋势,而鳞癌比例逐渐下降,这与体检发现得诊的患者比例逐年增高有关。(4)因呼吸系统相关症状就诊而确诊的肺癌患者中,晚期肺癌(IIIB-IV期)的比例显著高于因体检发现而确诊的患者,而早期(0-1期)比例显著低于后者,提示通过常规CT检查可使更多患者在早期得以诊断。(5)腺癌患者中女性EGFR基因突变阳性率约是男性的两倍,Exon21 L858R和Exon19 DEL是最常见突变类型。
[Abstract]:Background: lung cancer has become the highest incidence of cancer, mortality is the first among all the tumors in.2015, China's 733300 new cases of lung cancer, 610200 cases of death. So far our registration clinical information on lung cancer patients is not perfect, it also leads to clinical information related to lung cancer patients in China include: histopathological staging, the proportion of patients, smoking, gene mutation is not clear. On the other hand, China's lung cancer mortality rate is also higher than the world average level, and the lack of early detection and early diagnosis, about 2/3 patients are diagnosed at advanced stage. Over the past 5 years, with the medical insurance in me in China, especially in the eastern coastal areas of popularity, more and more patients to early diagnosis and treatment of early diagnosis in patients with increased. Whether bring different subsets changes is unclear. Objective: in this study, a large Eastern China From the type of general hospital lung cancer patients as the research object, aims to analyze the past 5 years (2011-2015) clinical features and trends of newly diagnosed lung cancer patients, and clinical characteristics and trends of patients with lung cancer in China have a more detailed understanding. Methods: a retrospective study in January 2011 -2015 year in December in affiliated the second hospital of Zhejiang University medical college first diagnosed as lung cancer patients, all patients were confirmed by lung biopsy or cytology or histopathology examination confirmed surgical resection. Patients with clinical information, imaging data through the hospital information management system (HIS). The diagnosis of lung cancer staging principle in the seventh edition of TNM staging is based on the standard of spass 20. Through statistical analysis of the data collected. Results: after 2011-2015 years, the new diagnosis of lung cancer were 5779 cases, including 3719 cases of male, mean age 62.7 years; 2060 were female , the average age of 59.7 years. Of different pathological types were as follows: 60% adenocarcinoma, 25.6% squamous cell carcinoma, small cell lung cancer 8.5%, large cell lung cancer 0.6%, 1% adenosquamous carcinoma, other 1.6% non-small cell lung cancer, adenocarcinoma ratio can not clear classification of pathological types of 2.8%. women (86.9%) was significantly higher than that of male (45.1%) for the past 5 years, no related respiratory symptoms and physical findings were due to the proportion of patients increased year by year, from 21.6% to 27.5%; at the same time the proportion of patients with adenocarcinoma was increased (from 54.1% to 62.5%), the proportion of squamous cell carcinoma is decreased (from 31.8% to 23.4%), small cell lung cancer accounted for little change. Due to respiratory and pulmonary symptoms and diagnosis of lung cancer in patients with advanced non-small cell lung cancer (TNM stage III B- IV) ratio reached 50.7%, far higher than for physical examination and diagnosis of patients (21.4%), and early (0- stage) ratio is significantly lower than the latter (20. 3%vs56.6%). Diagnosed lung cancer patients, male smokers accounted for 80.2%, while women with a history of smoking accounted for only 2.7%.509 patients, including 440 adenocarcinoma, 61 cases of squamous cell carcinoma and 8 cases of adenosquamous carcinoma patients received detection of mutations in the EGFR gene results showed that the mutation rate of 66% female patients with adenocarcinoma of the EGFR gene in Exon21, L858R and Exon19 DEL are the most common type of mutations, accounted for 91% of male patients with adenocarcinoma; EGFR gene mutation rate was 37%, Exon21L858R and Exon19DEL accounted for 88%.61 cases of squamous cell carcinoma patients, only one patient of Exon20 S768I mutation in.8 cases of adenosquamous carcinoma in 6 cases of patients with EGFR mutation positive. Conclusion: This study analyzes and the clinical features of lung cancer patients from many aspects including age distribution, gender, smoking history, pathological type, histological structure, tumor staging, gene mutation detection, the conclusions are as follows: (1) in various pathological subtypes of lung cancer, adenocarcinoma is the most common type, Female adenocarcinoma proportion is as high as 86.9%, which may be related to Chinese women with low smoking rates. (2) in the past 5 years, due to the increasing proportion of patients diagnosed physical examination revealed adenocarcinoma patients in the proportion reached 84%, but due to related symptoms of respiratory system were diagnosed with lung cancer in the proportion of adenocarcinoma is only 55%. (3) in the past 5 years, the proportion of patients with adenocarcinoma showed a gradual upward trend, while the proportion of squamous cell carcinoma is gradually decreased, and the examination found that the proportion of patients diagnosed increased year by year. (4) associated with respiratory symptoms were diagnosed in patients with lung cancer, lung cancer (IIIB-IV) the ratio was significantly higher than for physical examination and diagnosed early, and (0-1) was significantly lower than that of the latter, prompted by the conventional CT examination can make more patients can be diagnosed at an early stage. (5) female patients with adenocarcinoma in EGFR gene mutation rate is about two times of the male, Exon2 1 L858R and Exon19 DEL are the most common mutation types.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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