168例肺腺癌患者预后因素分析

发布时间：2018-07-29 10:56

【摘要】：目的:肺癌是目前全世界公认的最常见的恶性肿瘤,由于其预后差,病死率高,生存期短,故危害严重。肺腺癌作为肺癌的主要病理类型,近年来其发病率呈上升趋势,因肺腺癌典型表现为小的外周病灶,不易被发现,且极易出现区域淋巴结和远处转移,故5年生存率低。但随着近年来研究的进展,治疗多样化及靶向药物的问世,肺腺癌患者的生存期较前明显延长,且个体间存在较大差异。因此,分析影响肺腺癌预后的因素显得尤为重要。我们都知道,影响肿瘤预后的因素有很多,通过对肺腺癌患者分析可发现,患者在自身因素、肿瘤情况及所接受治疗等方面均存在较大差异,主要表现在确诊年龄、性别、吸烟与否及吸烟数量、肿瘤分期及肿瘤细胞分化程度、是否存在脏器转移及具体转移部位、是否存在多脏器转移、是否行手术治疗、是否接受化疗及化疗周期数、是否放疗、是否接受过靶向治疗以及具体应用的哪种靶向药物等方面。本课题主要探讨上述各因素对肺腺癌预后的影响,旨在找出影响肺腺癌预后的临床因素,为肺腺癌患者开展个体化治疗、延长生存期提供理论依据。方法:以2010年1月至2012年12月间首次就诊于秦皇岛市第一医院经病理学检查确诊为肺腺癌且无其他严重基础疾病及未接受过任何抗肿瘤治疗的患者为研究对象。共收集168例肺腺癌患者,对患者年龄、性别、吸烟情况、恶性肿瘤家族史、肿瘤分期及分化程度、脏器转移情况及具体治疗方案等信息进行详细记录,电话随访所有患者至2015年12月31日,记录患者总生存期作为预后指标。统计数据均采用SPSS17.0统计软件进行统计分析,采用Kaplan-Meier生存分析、Log-rank检验分析比较各临床特征对预后的影响,采用Cox回归模型进行多因素分析,找出肺腺癌患者预后的独立因素,以P0.05为差异有统计学意义。结果:对168例肺腺癌患者进行随访,截止到2015年12月31日,失访9例,随访率94.6%,存活11例,因肺癌死亡148例。分析168例肺腺癌患者预后情况,其总生存期为0.5个月到68.2个月,中位生存期为14.2个月,1年生存率为60.2%,2年生存率为34.1%,3年生存率为20.2%。综合分析168例肺腺癌患者临床特征对其预后的影响,单因素分析可见肿瘤分期、肿瘤细胞分化程度、确诊时是否存在脑、骨、肝等脏器的转移及是否同时存在多器官转移、是否手术治疗、化疗与否及化疗周期数、是否应用过靶向治疗均可影响肺腺癌患者的预后(p值均0.05),而患者确诊年龄、性别、吸烟与否及吸烟数量、恶性肿瘤家族史、是否接受过放疗等因素对预后无明显影响(p值均0.05)。靶向治疗改善了肺腺癌患者的预后,在本研究中,共计69例肺腺癌患者接受了靶向治疗,中位生存期为21.6个月,所使用的靶向治疗药物主要有两类,小分子酪氨酸激酶抑制剂(tyrosinekinaseinhibitors,tki)类药物和抗肿瘤血管生成(单抗)类药物。其中口服tki类药物者48例,中位生存期为19.6个月,使用抗肿瘤血管生成类药物者14例,中位生存期为32.2个月,两种药物均有使用者7例,中位生存期为21.6个月,但统计学分析显示三者中位生存期间无明显差异(p=0.230)。在治疗方案选择上,单纯靶向治疗者6例,中位生存期为13.5个月,既应用靶向治疗又接受化疗者23例,中位生存期为24.2个月,既应用靶向治疗又接受放疗者9例,中位生存期为12.7个月,既应用靶向治疗又接受放化疗者31例,中位生存期为30.6个月,统计学分析显示各组间中位生存期有差异(p=0.020),也就是说既应用靶向治疗又接受放化疗者中位生存期最长。将上述单因素分析得出的对肺腺癌预后有影响的9项因素引入cox比例风险模型,结果显示肿瘤分期、肿瘤细胞分化程度、确诊时伴有脑转移、确诊时伴有骨转移、确诊时伴有肝转移、是否接受过手术治疗、化疗与否及化疗周期数、是否应用过靶向治疗共计8项临床特征是影响肺腺癌预后的独立因素(p值均0.05)。结论:1、肺腺癌患者预后受肿瘤情况、治疗方式等多因素影响。2、肿瘤分期、肿瘤细胞分化程度、脑转移、骨转移、肝转移、手术、化疗及应用靶向治疗均是影响肺腺癌患者预后的独立因素。3、靶向治疗可改善肺腺癌患者的预后,既应用靶向治疗又行放化疗可延长肺腺癌患者的生存期。
[Abstract]:Objective: lung cancer is the most common malignant tumor in the world. Because of its poor prognosis, high mortality and short survival time, lung adenocarcinoma is the main pathological type of lung cancer. In recent years, the incidence of lung adenocarcinoma is on the rise. The typical manifestation of lung adenocarcinoma is small peripheral focus, it is not easy to be found, and regional lymph node is easy to appear. With the distant metastasis, the 5 year survival rate is low. But with the progress of research in recent years, the survival period of the patients with lung adenocarcinoma is longer than before, and there is a great difference between individuals. Therefore, the factors that affect the prognosis of lung adenocarcinoma are particularly important. We all know that the factors affecting the prognosis of the tumor are very important. More, by analyzing the patients with lung adenocarcinoma, it is found that the patients have great differences in their own factors, tumor conditions and treatment, such as the age, sex, smoking and smoking, the number of smoking and smoking, the stage of tumor and the degree of differentiation of the tumor cells, whether they exist in the organs and the specific metastatic sites, and whether there are multiple organs. Whether surgery is performed, whether or not the number of chemotherapy and chemotherapy cycles, whether radiotherapy, whether the target therapy is accepted, and what kind of targeted drugs are used, this subject is mainly to explore the effects of these factors on the prognosis of lung adenocarcinoma, in order to find out the clinical factors affecting the prognosis of lung adenocarcinoma and to develop individuals for lung adenocarcinoma. Methods: a total of 168 patients with lung adenocarcinoma were collected from January 2010 to December 2012, and 168 patients with lung adenocarcinoma were collected for the first time in Qinhuangdao First Hospital. The information of smoking, family history of malignant tumor, tumor stage and differentiation, organ metastasis and specific treatment were recorded in detail. All patients were followed up to December 31, 2015 by telephone, and the total survival time was recorded as a prognostic indicator. Statistical data were statistically analyzed by SPSS17.0 software, and Kaplan-Meie R survival analysis, Log-rank test analysis and comparison of the impact of the clinical features on the prognosis, using the Cox regression model for multiple factors analysis to find out the independent factors of the prognosis of the lung adenocarcinoma, the difference of P0.05 was statistically significant. Results: 168 cases of lung adenocarcinoma were followed up to December 31, 2015, 9 cases were lost, the follow-up rate was 94.6%, survival. 11 cases of lung cancer died in 148 cases. The prognosis of 168 cases of lung adenocarcinoma was analyzed. The total survival period was 0.5 months to 68.2 months, the median survival period was 14.2 months, the 1 year survival rate was 60.2%, the 2 year survival rate was 34.1%, and the 3 year survival rate was 20.2%. comprehensive analysis of the clinical characteristics of the patients with lung adenocarcinoma. The single factor analysis showed the tumor. Stage, the degree of differentiation of tumor cells, whether there is the metastasis of brain, bone, liver and other organs at the time of diagnosis, whether there is multiple organ transfer at the same time, whether surgical treatment, chemotherapy or not and the number of chemotherapy cycles, and whether the use of targeted therapy can affect the prognosis of patients with lung adenocarcinoma (P value is 0.05), and the age, sex, smoking and smoking and smoking number of patients are confirmed. Dose, family history of malignant tumor and whether or not radiotherapy and other factors have no significant influence on prognosis (P value is 0.05). Targeted therapy improves the prognosis of lung adenocarcinoma. In this study, 69 cases of lung adenocarcinoma received targeted therapy with a median survival period of 21.6 months, and there were two types of targeted therapy drugs, small molecule tyrosine. Tyrosinekinaseinhibitors (tyrosinekinaseinhibitors, TKI) drugs and antitumor angiogenesis (Dan Kang) drugs. Among them, 48 cases were taken orally, the median survival period was 19.6 months, 14 cases were used antitumor angiogenesis drugs, the median survival period was 32.2 months, two drugs were used in 7 cases, and the median survival period was 21.6 months. The analysis showed that there was no significant difference in the median survival of the three patients (p=0.230). In the choice of treatment, 6 cases were only targeted therapy, the median survival period was 13.5 months, 23 cases were both targeted and received chemotherapy, the median survival period was 24.2 months, both targeted and radiotherapy 9 cases, the median survival period was 12.7 months, both 31 patients with radiotherapy and chemotherapy were treated with targeted therapy and the median survival period was 30.6 months. Statistical analysis showed that the median survival time was different between each group (p=0.020), that is to say, the median survival period was the longest in both targeted and chemoradiotherapy. 9 factors influencing the prognosis of lung adenocarcinoma by the above single factor analysis were introduced into the Cox ratio. The results showed that the tumor stage, the degree of tumor cell differentiation, the diagnosis accompanied by brain metastases, the diagnosis accompanied by the bone metastasis, the diagnosis accompanied by the liver metastasis, whether the liver metastases were diagnosed, whether the surgery was accepted, the chemotherapy or not and the number of chemotherapy cycles, and whether the 8 clinical features of the target therapy were independent factors (P value was 0). 5) 5) conclusion: 1, the prognosis of lung adenocarcinoma patients is affected by tumor condition, treatment mode and other factors affecting.2, tumor staging, tumor cell differentiation, brain metastasis, bone metastasis, liver metastasis, operation, chemotherapy and targeted therapy are independent factors affecting the prognosis of lung adenocarcinoma patients.3, targeted therapy can improve the prognosis of lung adenocarcinoma, both target treatment and treatment can be used. Radiotherapy and chemotherapy can prolong the survival of patients with lung adenocarcinoma.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R734.2

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