肺癌切除术后应用非甾体类抗炎药对术后发热患者预后的影响
发布时间：2019-02-17 13:10
【摘要】：研究背景与目的在我国常见的各种类型的恶性肿瘤中,肺癌的发病率和死亡率都居于首位。肺癌通常可以分为两大类,即非小细胞肺癌(NSCLC)和小细胞肺癌(SCLC)。对于早、中期非小细胞肺癌患者而言,进行手术治疗对他们预后的改善有着十分重大的意义,但与此同时,手术治疗会不可避免的带来一些问题。进行手术治疗之后,患者往往会出现各种类型的并发症,如术后发热、疼痛、炎症等等。非甾体类抗炎药(NSAIDs)是一类在临床上应用非常广泛的药物,在外科手术治疗中,经常被用于缓解术后的发热、疼痛、炎症等。此外,已有很多研究表明非甾体类抗炎药具有抗肿瘤活性,可以在一定程度上降低部分肿瘤的发生率和致死率。行非小细胞肺癌切除术后应用非甾体类抗炎药对术后发热患者的预后到底会有怎样的影响,目前尚没有相关的研究或者报道。因此,就这一问题,我们开展了一项相关的回顾性研究。本研究旨在分析和探讨术后发热患者应用非甾体类抗炎药对其无进展生存期(PFS)和总生存期(OS)的影响。研究方法我们对2011年7月到2013年6月期间在山东省立医院胸外科做过非小细胞肺癌切除术的患者的临床资料(包括性别、年龄、吸烟史、临床病理资料、术后随访资料、术后应用非甾体类抗炎药的种类及剂量等)进行了收集与整理,并对这些临床资料进行了回顾性分析。通过Kaplan-Meier生存曲线法和Cox回归分析法,我们对患者的临床资料进行了生存分析,并应用亚组分析的方法评估术后应用非甾体类抗炎药对各亚组患者人群的作用。此项回顾性研究的主要观察终点为总生存期,次要观察终点为无进展生存期。研究结果此项回顾性研究一共纳入了 347例接受了手术治疗的非小细胞肺癌患者。评估术后应用非甾体类抗炎药与各临床病理信息是否相关时,卡方检验结果显示:术后是否应用非甾体类抗炎药只与病理组织类型(P=0.013)相关,而与其他各临床因素没有统计学意义上的关联。评估各项临床信息与患者生存预后之间的关系时,多因素Cox回归分析结果显示:术后应用非甾体类抗炎药的非小细胞肺癌患者的总生存期(HR:0.528,95%CI:0.278-0.884,P=0.006)和无进展生存期(HR:0.557,95%CI:0.317-0.841,P=0.002)与未应用非甾体类抗炎药的非小细胞肺癌患者有显著性差异。亚组分析结果表明:在高龄、男性、低吸烟指数、低分化和非腺癌患者的亚组中,术后应用非甾体类抗炎药的非小细胞肺癌患者的总生存期与未应用非甾体类抗炎药的非小细胞肺癌患者有显著性差异。结论在行非小细胞肺癌切除术的术后发热患者中,尤其是在高龄、男性、低吸烟指数、低分化和非腺癌这些亚组中,术后应用非甾体类抗炎药的患者比没有应用非甾体类抗炎药的患者预后更好。应用非甾体类抗炎药可以改善术后发热患者的预后,给患者带来更多的临床获益。
[Abstract]:Background and objective Lung cancer is the leading cause of morbidity and mortality among the common types of malignant tumors in China. Lung cancer can be divided into two main categories, namely, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). For early and medium-term non-small cell lung cancer patients, surgical treatment has great significance to improve their prognosis, but at the same time, surgical treatment will inevitably bring some problems. After surgical treatment, patients often have a variety of complications, such as postoperative fever, pain, inflammation and so on. Non-steroidal anti-inflammatory drug (NSAIDs) is a kind of widely used drugs in clinic. It is often used to relieve postoperative fever, pain, inflammation and so on in surgical treatment. In addition, many studies have shown that non-steroidal anti-inflammatory drugs have anti-tumor activity, which can reduce the incidence and mortality of some tumors to a certain extent. There is no relevant research or report on the effect of NSAIDs on the prognosis of postoperative fever patients after resection of NSCLC. Therefore, we have carried out a related retrospective study on this issue. The purpose of this study was to investigate the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on progressive survival (PFS) and total survival (OS) in patients with fever after operation. Methods from July 2011 to June 2013, we studied the clinical data (including sex, age, smoking history, clinicopathological data, postoperative follow-up data) of patients with non-small cell lung cancer (NSCLC) who had been performed in thoracic surgery of Shandong Provincial Hospital from July 2011 to June 2013. The kinds and doses of nonsteroidal anti-inflammatory drugs were collected and sorted, and the clinical data were analyzed retrospectively. By means of Kaplan-Meier survival curve and Cox regression analysis, we analyzed the clinical data of the patients, and evaluated the effect of NSAIDs on the patients after operation by subgroup analysis. The primary observation endpoint of this retrospective study was the total survival period, and the secondary observation endpoint was progressive survival. Results the retrospective study included 347 patients with non-small cell lung cancer who underwent surgical treatment. To assess the correlation between postoperative application of NSAIDs and clinicopathological information, chi-square test showed that the use of NSAIDs after surgery was only associated with pathological tissue type (P0. 013). There was no statistically significant correlation with other clinical factors. When evaluating the relationship between clinical information and survival and prognosis of patients, multivariate Cox regression analysis showed that the total survival time (HR:0.528,95%CI:0.278-0.884,) of patients with NSAIDs after operation was higher than that of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with non-small cell lung cancer (NSCLC). P0. 006) and progression free survival (HR:0.557,95%CI:0.317-0.841,P=0.002) were significantly different from those of non steroidal anti-inflammatory drugs (NSAIDs) in patients with non-small cell lung cancer (NSCLC). Subgroup analysis showed that in elderly, male, low smoking index, low differentiation and non-adenocarcinoma subgroups, There was a significant difference between the total survival time of patients with NSCLC treated with non-steroidal anti-inflammatory drugs (NSAIDs) and non-steroidal anti-inflammatory drugs (NSAIDs). Conclusion in patients with postoperative fever after non-small cell lung cancer resection, especially in the elderly, male, low smoking index, low differentiation and non-adenocarcinoma subgroups, Postoperative NSAIDs had a better prognosis than those without NSAIDs. The application of non-steroidal anti-inflammatory drugs can improve the prognosis of postoperative patients with fever and bring more clinical benefits.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
本文编号：2425199
[Abstract]:Background and objective Lung cancer is the leading cause of morbidity and mortality among the common types of malignant tumors in China. Lung cancer can be divided into two main categories, namely, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). For early and medium-term non-small cell lung cancer patients, surgical treatment has great significance to improve their prognosis, but at the same time, surgical treatment will inevitably bring some problems. After surgical treatment, patients often have a variety of complications, such as postoperative fever, pain, inflammation and so on. Non-steroidal anti-inflammatory drug (NSAIDs) is a kind of widely used drugs in clinic. It is often used to relieve postoperative fever, pain, inflammation and so on in surgical treatment. In addition, many studies have shown that non-steroidal anti-inflammatory drugs have anti-tumor activity, which can reduce the incidence and mortality of some tumors to a certain extent. There is no relevant research or report on the effect of NSAIDs on the prognosis of postoperative fever patients after resection of NSCLC. Therefore, we have carried out a related retrospective study on this issue. The purpose of this study was to investigate the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on progressive survival (PFS) and total survival (OS) in patients with fever after operation. Methods from July 2011 to June 2013, we studied the clinical data (including sex, age, smoking history, clinicopathological data, postoperative follow-up data) of patients with non-small cell lung cancer (NSCLC) who had been performed in thoracic surgery of Shandong Provincial Hospital from July 2011 to June 2013. The kinds and doses of nonsteroidal anti-inflammatory drugs were collected and sorted, and the clinical data were analyzed retrospectively. By means of Kaplan-Meier survival curve and Cox regression analysis, we analyzed the clinical data of the patients, and evaluated the effect of NSAIDs on the patients after operation by subgroup analysis. The primary observation endpoint of this retrospective study was the total survival period, and the secondary observation endpoint was progressive survival. Results the retrospective study included 347 patients with non-small cell lung cancer who underwent surgical treatment. To assess the correlation between postoperative application of NSAIDs and clinicopathological information, chi-square test showed that the use of NSAIDs after surgery was only associated with pathological tissue type (P0. 013). There was no statistically significant correlation with other clinical factors. When evaluating the relationship between clinical information and survival and prognosis of patients, multivariate Cox regression analysis showed that the total survival time (HR:0.528,95%CI:0.278-0.884,) of patients with NSAIDs after operation was higher than that of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with non-small cell lung cancer (NSCLC). P0. 006) and progression free survival (HR:0.557,95%CI:0.317-0.841,P=0.002) were significantly different from those of non steroidal anti-inflammatory drugs (NSAIDs) in patients with non-small cell lung cancer (NSCLC). Subgroup analysis showed that in elderly, male, low smoking index, low differentiation and non-adenocarcinoma subgroups, There was a significant difference between the total survival time of patients with NSCLC treated with non-steroidal anti-inflammatory drugs (NSAIDs) and non-steroidal anti-inflammatory drugs (NSAIDs). Conclusion in patients with postoperative fever after non-small cell lung cancer resection, especially in the elderly, male, low smoking index, low differentiation and non-adenocarcinoma subgroups, Postoperative NSAIDs had a better prognosis than those without NSAIDs. The application of non-steroidal anti-inflammatory drugs can improve the prognosis of postoperative patients with fever and bring more clinical benefits.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2
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