233例Ⅰ期非小细胞肺癌临床病理特征与预后分析

发布时间：2018-06-08 11:49

本文选题：非小细胞肺癌 + 预后　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:回顾性分析我院Ⅰ期非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者的临床、病理特征,并研究与其预后的相关因素。方法:收集2006年1月至2013年12月在广西医科大学附属肿瘤医院胸瘤外科行手术治疗的233例Ⅰ期NSCLC患者的住院病历资料。记录患者首发症状、性别、年龄、吸烟史、术前血小板计数(Platelet,PLT)、术前血红蛋白(hemoglobin,HGB)浓度、术前癌胚抗原(carcinoma embryonic antigen,CEA)浓度、手术方式,包括开胸手术及电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)、淋巴结清扫情况、肿瘤最大径、肿瘤部位、病理类型、分化程度、脏层胸膜侵犯(Visceral pleura invasion,VPI)、脉管癌栓(vessel invasion,VI),包括血管癌栓(blood vessel invasion,BVI)和淋巴管癌栓(lymphatic vessel invasion,LVI)、辅助化疗及生存情况,研究上述因素对患者生存率的影响。通过电话、门诊等形式进行随访及查询我院随访办公室资料以获取生存数据。采用SPSS17.0软件进行统计分析,以构成比描述临床、病理特征。运用寿命表法计算全组患者1、3、5年累积生存率,单因素生存分析予KaplanMeier法(Log-rank检验),多因素分析予COX回归模型。采用X 2检验评估VI、VPI与其他临床、病理特征之间的关系。以P0.05为有统计学意义。结果:1.临床、病理特征男性发病率(57.9%)比女性(42.1%)稍高,男女之比为1.4:1。随着年龄增高,发病率均呈先升后降的变化趋势,51-70岁发病率达高峰(70.9%)。首发症状以咳嗽(53.6%)为主,其次为咳痰。主动吸烟91例(39.1%),无吸烟142(60.9%),男性吸烟比例明显高于女性(65.2%vs3.1%)。肿瘤位于右肺较左侧稍多(58.4%vs41.6%),上叶居多(59.6%)。ia期占71.2%,ib期占28.8%。肿瘤最大径3cm(54.9%)稍多于肿瘤最大径≥3cm,≤5cm(45.1%)。病理类型以腺癌为主(76.0%),其次为鳞癌(15.5%)。高中分化比例(67.8%)高于低分化(32.2%)。bvi(4.7%)、lvi(4.3%)、vpi(9.0%),所占比例均较小。hgb110g/l(7.7%)、plt300×109/l(18.0%)及cea5.0μg/l(32.2%)患者所占比例均较小。开胸手术146例(62.7%),vats87例(37.3%),清扫纵隔淋巴结组数≥3组178例(76.4%),清扫淋巴结总个数≥6枚206例(88.4%),行辅助化疗共49例(21.0%)。2.生存预后分析全组患者术后1年、3年、5年累积生存率分别为96.5%、88.8%、77.0%。单因素生存分析结果显示性别、吸烟、hgb、plt、cea、手术方式、肿瘤位置及vpi对预后的影响均无统计学意义(p0.05)。年龄、肿瘤最大径、tnm分期、t分期、病理类型、分化程度、vi、清扫纵隔淋巴结组数、清扫淋巴结总个数与预后有关(p0.05)。多因素分析结果显示肿瘤最大径≥3cm,≤5cm、分化程度低、vi、清扫纵隔淋巴结的组数3组及清扫淋巴结总个数6枚均是影响预后的独立高危因素。3.ib期nsclc未能从术后辅助化疗中获益。4.vi多见于低分化肿瘤。结论:1.年龄、肿瘤最大径、tnm分期、t分期、病理类型、分化程度、vi、清扫纵隔淋巴结组数、清扫淋巴结总个数与i期nsclc预后密切相关,其中肿瘤最大径≥3cm,≤5cm、分化程度低、VI、清扫纵隔淋巴结组数3组及清扫淋巴结总个数6枚均是影响预后的独立高危因素,建议对高危患者行术后辅助化疗从而延长远期生存。2.VATS与开胸手术对I期NSCLC患者生存的影响无明显差异。3.Ib期NSCLC不能从术后辅助化疗中获益,可能使伴高危因素患者获益。4.VI多见于低分化肿瘤。
[Abstract]:Objective: To review the clinical and pathological features of Non-small cell lung cancer (NSCLC) patients in phase I of our hospital and to study the related factors of its prognosis. Methods: to collect the hospitalization records of 233 stage I NSCLC patients who were operated in the external department of the Thoracic Tumor Hospital of Guangxi Medical University from January 2006 to December 2013. Data. Records of patients' initial symptoms, sex, age, smoking history, preoperative platelet count (Platelet, PLT), preoperative hemoglobin (hemoglobin, HGB) concentration, preoperative carcinoembryonic antigen (carcinoma embryonic antigen, CEA) concentration, surgical methods, including thoracotomy and video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery, VATS), and drenching. The maximum diameter, tumor site, tumor location, pathological type, degree of differentiation, Visceral pleura invasion, VPI, vessel invasion (VI), vascular tumor thrombus (blood vessel invasion, BVI), and lymphatic tumor thrombus (lymphatic), adjuvant chemotherapy and survival were studied, and the factors mentioned above were studied. The effect of the patient's survival rate was followed up by telephone and outpatient service and inquiring into the data of the follow-up office in our hospital to obtain the survival data. The SPSS17.0 software was used to analyze the clinical and pathological features. The cumulative survival rate of the whole group of patients was calculated by using the life table method, and the single factor survival analysis was given to KaplanMeier. The method (Log-rank test), multivariate analysis was given to the COX regression model. The relationship between VI, VPI and other clinical and pathological features was evaluated by X 2 test. The results were statistically significant with P0.05. Results: 1. clinical and pathological male incidence (57.9%) was slightly higher than that of women (42.1%), and the ratio of male and female to 1.4:1. increased with age, and the incidence of the disease increased first and then descended. The incidence of the 51-70 year old was up to the peak (70.9%). The first symptoms were cough (53.6%), followed by expectoration, 91 (39.1%), 142 (60.9%) without smoking. The male smoking ratio was significantly higher than that of the female (65.2%vs3.1%). The tumor located in the right lung was slightly more than that in the left (58.4%vs41.6%), the upper leaves were more (59.6%).Ia, 71.2%, and the IB period accounted for the 28.8%. tumor most. The largest diameter 3cm (54.9%) was slightly more than the maximum diameter of the tumor more than 3cm and less than 5cm (45.1%). The pathological type was mainly adenocarcinoma (76%), and the second was squamous cell carcinoma (15.5%). The proportion of high school differentiation (67.8%) was higher than that of low differentiation (32.2%).Bvi (4.7%), LVI (4.3%), VPI (9%), and the proportion of.Hgb110g/l (7.7%), plt300 * 109/l (18%) and cea5.0 mu g/l (32.2%) patients were all in proportion. Smaller. 146 cases (62.7%), vats87 (37.3%), 178 cases (76.4%) of lymph node dissection of mediastinum, 178 cases (76.4%), total number of lymph nodes in 206 (88.4%), 49 cases (21%) survival after adjuvant chemotherapy (49 cases (21%) survival analysis, 1 years after operation, 3 years, 3 years, 77.0%. single factor survival analysis results showed significant results. The effects of sex, smoking, HGB, PLT, CEA, operation mode, tumor location and VPI on prognosis were not statistically significant (P0.05). Age, maximum diameter of tumor, TNM stage, T stage, pathological type, differentiation degree, VI, the number of lymph nodes in mediastinum, total number of lymph node dissection and prognosis (P0.05). The results of multifactor analysis showed that the maximum diameter of tumor was more than 3C. M, < 5cm, low degree of differentiation, VI, the number of 3 groups of lymph node dissection of mediastinum and 6 of the total number of lymph nodes were all the independent high risk factors affecting the prognosis. NSCLC failed to benefit.4.vi from postoperative adjuvant chemotherapy. Conclusion: the 1. age, the maximum diameter of the tumor, the TNM stage, the T staging, the pathological type, the degree of differentiation, VI, and sweep. The total number of septum groups was closely related to the prognosis of I phase NSCLC. The maximum diameter of the tumor was more than 3cm, less than 5cm, and the degree of differentiation was low. VI, the number of 3 groups of lymph node dissection and the total number of 6 lymph nodes were all the independent risk factors affecting the prognosis. It is suggested that adjuvant chemotherapy for high-risk patients should be performed to prolong the long-term survival of.2.. There is no significant difference in the impact of VATS and thoracotomy on the survival of patients with stage I NSCLC..3.Ib NSCLC can not benefit from postoperative adjuvant chemotherapy, and may benefit patients with high risk factors to gain more.4.VI in low differentiated tumors.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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