肺癌转移患者的临床特点及其预后分析

发布时间：2018-06-24 03:33

本文选题：肺癌 + 转移　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]1.回顾性分析我院初诊原发性肺癌患者的病例资料,研究肺癌患者的临床特点、肺癌患者有无发生转移与临床相关指标的差异。2.分析我院肺癌骨转移、肺癌脑转移及肺癌肝转移患者的临床特点及预后。[方法]应用昆明医科大学第三附属医院(云南省肿瘤医院)病案系统检索2014年1月1日至2014年12月31日首诊我院确诊为原发性肺癌患者的临床资料,筛选符合入组标准的病例880例。记录患者首诊的临床相关资料,并通过电话随访获得生存资料。根据研究目的,选取部分数据应用SPSS 20.0软件进行统计学分析,探究本组原发性肺癌患者的临床特点及转移患者的临床特点。对是否发生转移将患者进行分组,采用统计学方法比较各项观察指标的差异,以P0. 05为差异具有统计学意义。分析肺癌骨转移组、肺癌脑转移组及肺癌肝转移组患者的临床特点,采用Kaplan-Meier的log-rank检验进行患者生存率的单因素分析,采用Cox比例风险模型多因素分析方法进行患者生存率的多因素分析。[结果]纳入符合条件的原发性肺癌病例880例,男女比例2. 5:1。诊断中位年龄为58岁,高发年龄在40-70岁间。NSCLC 711例,占80. 8%。病理类型为腺癌474例(53.9%),鳞癌226例(25.7%)、小细胞肺癌132例(15.0%),其他病理类型48例(5.4%)。临床分期:Ⅲ期、Ⅳ期最多,共693例,占全部病例的78. 7%,其中Ⅳ期390例(44. 3%)。Ⅳ期肺癌患者中,骨转移169例(43. 33%);脑转移88例(22. 56%),双肺转移86例(22.05%);胸膜转移73例(18.72%);肝转移60例(15.38%);其他部位转移较少。转移的患者的营养状况较未出现转移的患者差。出现转移的患者纤维蛋白原、血液粘滞度、肿瘤标志物均明显升高。肺癌骨转移患者169例,中位年龄58岁,男女比例1.5:1。病理学类型腺癌117例最多,其次是鳞癌22例,其他病理类型少见。78.1%的患者为多发骨转移。首诊时即有55.6%的患者存在骨相关事件。此组病例Kaplan-Meier分析Log-Rank法结果显示病理类型、血钙浓度、合并其他部位转移、肺部病灶手术治疗、化疗、靶向治疗、锶89治疗及双磷酸盐治疗与原发性肺癌骨转移患者的预后有相关性。Cox比例风险模型多因素分析显示化疗、靶向治疗和合并其他部位转移是肺癌骨转移的独立预后影响因子。肺癌脑转移患者88例,中位年龄58岁,男女比例约为2:1。病理类型腺癌48例最多,小细胞肺癌20例,其他病理类型较少。72. 7%的患者为多发脑转移,31. 8%患者出现颅高压。此组病例Kaplan-Meier分析Log-Rank法结果显示年龄、病理类型、白蛋白水平、化疗、靶向治疗、全脑放疗、治疗模式和肺癌脑转移预后有相关性。Cox比例风险模型多因素分析显示化疗和靶向治疗是肺癌脑转移的独立预后影响因子。肺癌肝转移患者60例,中位年龄59. 5岁,男女比例为3:1。肺癌肝转移患者中小细胞癌23例最多,其次是腺癌21例,其他病理类型较少。以多发肝转移为主,占73. 3%, 21. 7%的患者合并有肝炎病史。Kaplan-Meier分析Log-Rank法结果显示病理类型、靶向治疗和抗肿瘤治疗与肺癌肝转移的生存相关。Cox比例风险模型多因素分析显示病理类型和抗肿瘤治疗是肺癌肝转移的独立预后影响因子。[结论]原发性肺癌患者有年轻化趋势,且近半数患者初诊即出现转移。转移患者较无转移患者营养状态及肝肾功能差,高凝状态明显、血清肿瘤标志物明显升高。肺癌骨转移患者最多,腺癌及多发骨转移常见,肺癌骨转移患者合并其他部位转移、化疗、靶向治疗是独立预后因素。肺癌脑转移患者较多,肺癌脑转移患者化疗、靶向治疗是独立预后因素。肺癌肝转移患者较少,肺癌肝转移患者的病理类型、有无抗肿瘤治疗是独立预后因素。
[Abstract]:[Objective]1. retrospective analysis of the case data of primary lung cancer patients in our hospital, the clinical characteristics of lung cancer patients, the difference of metastasis and clinical related indexes of lung cancer patients with.2. analysis of the clinical characteristics and prognosis of lung cancer bone metastases, lung cancer and lung cancer patients in our hospital. [methods] apply the Kunming Medical University (method). Three affiliated hospital (Yunnan Cancer Hospital) medical record system retrieved the clinical data of the primary lung cancer patients first diagnosed in our hospital from January 1, 2014 to December 31, 2014, selected 880 cases in accordance with the standard of entry group, recorded the clinical data of the first diagnosis of the patients, and obtained the survival data by telephone interview. SPSS 20 software was used for statistical analysis to explore the clinical characteristics of the patients with primary lung cancer and the clinical characteristics of the patients with metastasis. The differences of the observation indexes were compared with the statistical methods, and the difference of the P0. 05 was statistically significant. The lung cancer bone metastasis group and lung were analyzed. The clinical characteristics of the patients with cancer brain metastasis and liver metastasis of lung cancer were analyzed by single factor analysis of the patient's survival rate by Kaplan-Meier log-rank test. Multifactor analysis of the patient's survival rate was carried out by the multifactor analysis of Cox proportional risk model. [results] were included in 880 cases of eligible primary lung cancer cases, the proportion of men and women was 2. 5:1. The median age of diagnosis was 58 years and 711 cases of.NSCLC with high incidence of age 40-70 years, 474 cases of adenocarcinoma (53.9%), 226 cases of squamous carcinoma (25.7%), 132 cases of small cell lung cancer (15%), and 48 cases (5.4%) with other pathological types. Clinical stages: Stage III, stage IV, most of all cases, among them, stage IV lung cancer. There were 169 cases (43.33%) of bone metastases, 88 cases of brain metastases (22.56%), 86 cases of double lung metastasis (22.05%), 73 cases of pleural metastasis (18.72%), 60 cases of liver metastasis (15.38%) and less metastasis. The nutritional status of the metastatic patients was less than that of those who had not been transferred. The fibrinogen, blood viscosity, and tumor markers were obvious in the metastatic patients. There were 169 cases of lung cancer with bone metastases in 169 cases, with a median age of 58 years, 117 cases of male and female pathological type adenocarcinoma, 22 cases of squamous cell carcinoma, and multiple bone metastases in other.78.1% patients with other pathological types. 55.6% of the patients had bone related events at the first diagnosis. The Kaplan-Meier analysis of Log-Rank showed the pathological class. Type, blood calcium concentration, combined other site metastasis, pulmonary focus operation, chemotherapy, targeting therapy, strontium 89 therapy, and bisphosphonate therapy and prognosis of patients with primary lung cancer with bone metastases, there is a correlation.Cox proportional risk model multifactor analysis shows chemotherapy, targeted therapy, and other site metastasis are independent prognosis of bone metastasis in lung cancer Ringing factor. 88 cases of lung cancer with brain metastases, with a median age of 58 years, 48 cases of 2:1. pathological type adenocarcinoma, 20 cases of small cell lung cancer, 20 cases of small cell lung cancer, multiple brain metastases in other patients with less.72. 7%, and 31.8% patients with cranial high pressure. This group of cases Kaplan-Meier analysis Log-Rank results showed age, pathological type, albumin Levels, chemotherapy, targeted therapy, whole brain radiotherapy, treatment model, and prognosis of lung cancer were correlated with.Cox proportional risk model multivariate analysis showed that chemotherapy and targeted therapy were independent prognostic factors of lung cancer. 60 cases of lung cancer patients with lung cancer were 59.5 years of age, and the proportion of men and women was small and medium cells of liver metastases in 3:1. lung cancer. There were 23 cases of cancer, followed by adenocarcinoma in 21 cases, other pathological types were less. Multiple liver metastases, accounting for 73.3%, 21.7% of the patients were combined with.Kaplan-Meier analysis of the history of hepatitis. The Log-Rank method showed the pathological type. The multiple factor analysis of the.Cox proportional risk model for the survival of the target therapy and the cancer treatment and the liver metastasis of lung cancer showed that the multiple factor analysis of the risk model of the survival of the liver metastasis of lung cancer showed the disease Type and antitumor therapy are the independent prognostic factors of liver metastasis in lung cancer. [Conclusion] the patients with primary lung cancer have a tendency to be young, and nearly half of the patients have metastasized first diagnosis. Adenocarcinoma and multiple bone metastasis are common, the patients with lung cancer with metastasis of other parts, chemotherapy and targeted therapy are independent prognostic factors. There are more patients with lung cancer with brain metastases, chemotherapy for lung cancer, and targeted therapy is an independent prognostic factor. The pathological type of lung cancer patients with lung cancer is less, and there is no antitumor treatment for patients with lung cancer. It is an independent prognostic factor.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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