回顾性分析术后辅助化疗对具有高危因素的IB期非小细胞肺癌预后的影响
发布时间：2018-08-09 19:12
【摘要】：目的:采用回顾性病例分析的方法研究术后辅助化疗对具有高危因素的IB期非小细胞肺癌(non-small cell lung cancer,NSCLC)5年无病生存率(5-year disease free survival rate,5y-DFS rate)的影响、临床病理特征与5y-DFS rate的相关性及术后辅助化疗对具有独立预后因素的患者5y-DFS rate的影响,为IB期NSCLC的治疗策略提供依据。材料与方法:通过联众数字化病案浏览系统搜集2008年1月1日至2012年1月1日期间大连医科大学附属第一医院收治的行肺切除术及淋巴结廓清术患者。根据病例选取及排除标准,符合条件且病例资料完整的IB期NSCLC患者共63例。统计患者临床病理特征:性别、年龄、组织学类型、分化程度、肿瘤最大径、脏层胸膜受累情况、脉管是否受侵、是否行楔形切除、是否行术后辅助化疗、化疗方案及化疗周期数。采用查阅电子病历资料及电话随访的方法对所有患者按计划进行随访。患者有任何复发症状、体征,可随时进行影像学检查。随访截止日期为2017年1月1日。采用SPSS 19.0对数据进行统计学分析。行辅助化疗与未行辅助化疗患者之间临床病理特征的差异性采用卡方检验。预后单因素分析应用Kaplan-Meier法,并绘制出生存曲线,用Log-rank检测统计学预后因素差异性。将单因素分析有意义及结合相关研究可能有意义的因素纳入COX比例风险模型中进行多因素分析,得出IB期NSCLC 5年无病生存率的独立影响因素。在探究术后辅助化疗对具有独立预后因素患者5y-DFS rate的影响时,采用分层log-rank检验。以p0.05为差异有统计学意义。结果:1、截止本研究随访终点2017年1月1日,63例IB期NSCLC患者中有20例出现复发转移,5y-DFS rate为66.3%。2、单因素分析结果显示:行术后辅助化疗的IB期NSCLC患者5年无病生存率为81.1%,未行术后辅助化疗的患者5年无病生存率为47.4%,与5y-DFS rate有相关性(p=0.012);低分化患者5年无病生存率为48.3%,中高分化患者5年无病生存率为78.4%,与5y-DFS rate有相关性(p=0.043);脉管受侵的患者5年无病生存率为56.4%,脉管未受侵的患者5年无病生存率为74.1%,与5y-DFS rate有相关性(p=0.039);楔形切除患者5年无病生存率为44.0%,非楔形切除的患者5年无病生存率为78.1%,与5y-DFS rate有相关性(p=0.016);胸膜受累的患者5年无病生存率为58.8%,胸膜未受累的患者5年无病生存率为86.7%,与5y-DFS rate无相关性,但p值为0.074,接近0.05;性别、年龄、组织学类型及肿瘤最大径与5y-DFS rate无相关性。3、多因素分析结果显示:肿瘤分化程度(p=0.037)、脏层胸膜受累(p=0.044)及脉管受侵(p=0.020)为IB期NSCLC患者5y-DFS rate的独立预后因素;术后辅助化疗为具有高危因素的IB期NSCLC患者5y-DFS rate的独立预后因素(p=0.015)。4、分层分析结果显示:脏层胸膜受累的IB期NSCLC患者,行术后辅助化疗其5y-DFS rate为77.6%,未行术后辅助化疗者5y-DFS rate为36.6%,p值为0.008,差异有统计学意义;脉管受侵的患者,行术后辅助化疗其5y-DFS rate为75.0%,未行术后辅助化疗者5y-DFS rate为33.3%,p值为0.030,差异有统计学意义;而对于低分化的患者,行术后辅助化疗与未行术后辅助化疗者5y-DFS rate差异无统计学意义。结论:1、对具有脏层胸膜受累、脉管受侵的IB期NSCLC患者行术后辅助化疗可能延缓疾病复发时间;2、术后辅助化疗可能为具有高危因素的IB期NSCLC 5年无病生存率的独立预后因素。
[Abstract]:Objective: To study the effect of postoperative adjuvant chemotherapy on the 5 year disease-free survival rate of non-small cell lung cancer (NSCLC) in IB stage non small cell lung cancer (5-year disease free survival rate, 5y-DFS) with a retrospective case analysis. The effect of 5y-DFS rate in patients with independent prognostic factors provides a basis for the treatment strategy of IB phase NSCLC. Materials and methods: collect pulmonary resection and lymph node dissection in the First Affiliated Hospital of Dalian Medical University from January 1, 2008 to January 1, 2012. A total of 63 patients with IB phase NSCLC were excluded from the criteria, and the clinicopathological features of the patients: sex, age, histological type, degree of differentiation, the maximum diameter of the tumor, the involvement of the pleura, whether the pulse tube was invaded, or whether the cuneiform resection was performed, the postoperative adjuvant chemotherapy, the chemotherapy regimen and the number of chemotherapy cycles. All patients were followed up by the methods of electronic medical records and telephone follow-up. The patients had any recurrent symptoms and signs and could be examined at any time. The deadline of follow-up was January 1, 2017. The data were statistically analyzed with SPSS 19. The clinicopathological features between adjuvant chemotherapy and non adjuvant chemotherapy were performed. The difference was based on Chi square test. The prognosis mono factor analysis was used Kaplan-Meier method, the birth memory curve was plotted and the difference of prognostic factors was detected by Log-rank. The single factor analysis was meaningful and the related research could be integrated into the COX proportional risk model for multi factor analysis, and the 5 year disease of NSCLC in IB period was found to be no disease. The independent influence factors of survival rate. In exploring the effect of postoperative adjuvant chemotherapy on 5y-DFS rate with independent prognostic factors, the stratified log-rank test was used. The difference between P0.05 and P0.05 was statistically significant. Results: 1, in the end of the study, 20 cases of IB stage NSCLC patients had relapse and metastasis, and 5y-DFS rate was 66.3. %.2, single factor analysis showed that the 5 year disease free survival rate of IB NSCLC patients with postoperative adjuvant chemotherapy was 81.1%. The 5 year disease-free survival rate of patients without postoperative adjuvant chemotherapy was 47.4% and 5y-DFS rate was associated (p=0.012); the 5 year disease-free survival rate of the low differentiated patients was 48.3%, the 5 year disease-free survival rate of middle and high differentiation patients was 78.4%, and 5y-DFS rat. E was related (p=0.043); the 5 year disease free survival rate of the patients with vascular invasion was 56.4%, the 5 year disease-free survival rate of the patients with unaffected vasculature was 74.1%, and the 5y-DFS rate was correlated (p=0.039); the 5 year disease free survival rate of the cuneiform excision patients was 44%, the 5 year disease free survival rate of the non wedge excised patients was 78.1%, and the chest was associated with the rate (p=0.016); chest (p=0.016); chest (p=0.016); chest. The 5 year disease-free survival rate of the patients with membrane involvement was 58.8%, the 5 year disease-free survival rate of the pleural unaffected patients was 86.7%, and there was no correlation with 5y-DFS rate, but the p value was 0.074, close to 0.05; sex, age, histological type and the tumor maximum diameter were not associated with 5y-DFS rate, and the multifactor analysis showed that the degree of tumor differentiation (p=0.037) and the dirty pleura received. P=0.044 and vascular invasion (p=0.020) were independent prognostic factors of 5y-DFS rate in IB phase NSCLC patients; postoperative adjuvant chemotherapy was an independent prognostic factor (p=0.015) for IB phase NSCLC patients with high risk factors (p=0.015).4. The 5y-DFS rate was 36.6% and the value of P was 0.008, and the difference was statistically significant. The 5y-DFS rate of the patients with vascular invasion was 75% after the postoperative adjuvant chemotherapy, the 5y-DFS rate was 33.3% and the p value was 0.030 without postoperative adjuvant chemotherapy, and the postoperative adjuvant chemotherapy and failure were performed for the patients with low differentiation. There was no significant difference in 5y-DFS rate of post adjuvant chemotherapy. Conclusion: 1, postoperative adjuvant chemotherapy for IB phase NSCLC patients with intravascular pleura involvement may delay the time of disease recurrence; 2, postoperative adjuvant chemotherapy may be an independent prognostic factor of IB stage NSCLC 5 year disease free survival with high risk factors.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2175038
[Abstract]:Objective: To study the effect of postoperative adjuvant chemotherapy on the 5 year disease-free survival rate of non-small cell lung cancer (NSCLC) in IB stage non small cell lung cancer (5-year disease free survival rate, 5y-DFS) with a retrospective case analysis. The effect of 5y-DFS rate in patients with independent prognostic factors provides a basis for the treatment strategy of IB phase NSCLC. Materials and methods: collect pulmonary resection and lymph node dissection in the First Affiliated Hospital of Dalian Medical University from January 1, 2008 to January 1, 2012. A total of 63 patients with IB phase NSCLC were excluded from the criteria, and the clinicopathological features of the patients: sex, age, histological type, degree of differentiation, the maximum diameter of the tumor, the involvement of the pleura, whether the pulse tube was invaded, or whether the cuneiform resection was performed, the postoperative adjuvant chemotherapy, the chemotherapy regimen and the number of chemotherapy cycles. All patients were followed up by the methods of electronic medical records and telephone follow-up. The patients had any recurrent symptoms and signs and could be examined at any time. The deadline of follow-up was January 1, 2017. The data were statistically analyzed with SPSS 19. The clinicopathological features between adjuvant chemotherapy and non adjuvant chemotherapy were performed. The difference was based on Chi square test. The prognosis mono factor analysis was used Kaplan-Meier method, the birth memory curve was plotted and the difference of prognostic factors was detected by Log-rank. The single factor analysis was meaningful and the related research could be integrated into the COX proportional risk model for multi factor analysis, and the 5 year disease of NSCLC in IB period was found to be no disease. The independent influence factors of survival rate. In exploring the effect of postoperative adjuvant chemotherapy on 5y-DFS rate with independent prognostic factors, the stratified log-rank test was used. The difference between P0.05 and P0.05 was statistically significant. Results: 1, in the end of the study, 20 cases of IB stage NSCLC patients had relapse and metastasis, and 5y-DFS rate was 66.3. %.2, single factor analysis showed that the 5 year disease free survival rate of IB NSCLC patients with postoperative adjuvant chemotherapy was 81.1%. The 5 year disease-free survival rate of patients without postoperative adjuvant chemotherapy was 47.4% and 5y-DFS rate was associated (p=0.012); the 5 year disease-free survival rate of the low differentiated patients was 48.3%, the 5 year disease-free survival rate of middle and high differentiation patients was 78.4%, and 5y-DFS rat. E was related (p=0.043); the 5 year disease free survival rate of the patients with vascular invasion was 56.4%, the 5 year disease-free survival rate of the patients with unaffected vasculature was 74.1%, and the 5y-DFS rate was correlated (p=0.039); the 5 year disease free survival rate of the cuneiform excision patients was 44%, the 5 year disease free survival rate of the non wedge excised patients was 78.1%, and the chest was associated with the rate (p=0.016); chest (p=0.016); chest (p=0.016); chest. The 5 year disease-free survival rate of the patients with membrane involvement was 58.8%, the 5 year disease-free survival rate of the pleural unaffected patients was 86.7%, and there was no correlation with 5y-DFS rate, but the p value was 0.074, close to 0.05; sex, age, histological type and the tumor maximum diameter were not associated with 5y-DFS rate, and the multifactor analysis showed that the degree of tumor differentiation (p=0.037) and the dirty pleura received. P=0.044 and vascular invasion (p=0.020) were independent prognostic factors of 5y-DFS rate in IB phase NSCLC patients; postoperative adjuvant chemotherapy was an independent prognostic factor (p=0.015) for IB phase NSCLC patients with high risk factors (p=0.015).4. The 5y-DFS rate was 36.6% and the value of P was 0.008, and the difference was statistically significant. The 5y-DFS rate of the patients with vascular invasion was 75% after the postoperative adjuvant chemotherapy, the 5y-DFS rate was 33.3% and the p value was 0.030 without postoperative adjuvant chemotherapy, and the postoperative adjuvant chemotherapy and failure were performed for the patients with low differentiation. There was no significant difference in 5y-DFS rate of post adjuvant chemotherapy. Conclusion: 1, postoperative adjuvant chemotherapy for IB phase NSCLC patients with intravascular pleura involvement may delay the time of disease recurrence; 2, postoperative adjuvant chemotherapy may be an independent prognostic factor of IB stage NSCLC 5 year disease free survival with high risk factors.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
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