2000年与2010年四川大学华西医院肺癌临床诊治特征的对比研究

Comparative Analysis of Clinical Features of Lung Cancer in West China Hospital in 2000 and 2010

背景与目的原发性支气管肺癌是最常见的恶性肿瘤之一,本研究旨在回顾性分析2000年与2010年四川大学华西医院原发性支气管肺癌临床特征的变化,为肺癌的早期诊断和治疗提供参考。方法收集2000年与2010年在四川大学华西医院住院的四川地区常住人口中初诊原发性支气管肺癌病例,对两组患者的主要就诊原因、发病到就诊时间、伴随基础疾病、合并肺癌的双原发癌、家族恶性肿瘤史、肿瘤位置、分化程度、肿瘤分期及首诊主要治疗方式等临床资料进行对比分析。结果收集有细胞学或组织学依据的肺癌病例共2,167例,其中2000年616例,2010年1,551例。10年中因体检而就诊的肺癌患者构成比上升(5.2%vs16.7%,P<0.001),肺癌患者发病到就诊时间缩短(P<0.001),伴家族恶性肿瘤史的肺癌患者增多(3.9%vs13.7%,P<0.001);鳞癌低分化癌构成比明显增加(59.4%vs76.7%,P=0.002),而腺癌低分化癌构成比明显减少(72.3%vs51.8%,P=0.002);非小细胞肺癌患者Ia期及IV期构成比明显上升(Ia期:1.0%vs4.5%,P<0.001;IV期:30.4%vs37.8%,P<0.001),IIIa期构成比明显下降(26.6%vs14.8%,P=0.002);治疗上非小细胞肺癌患者首诊采取化疗构成比上升(35.9%vs42.4%,P=0.007),IIIa期首诊采取手术者明显上升(41.8%vs63.4%,P=0.002),IV期首诊采取手术者明显下降(9.4%vs3.1%,P=0.001),小细胞肺癌患者首诊采取手术者明显下降(30.4%vs4.3%,P<0.001)。结论近十年肺癌患者的临床特征部分已产生了较为明显的变化,根据这些变化选择更适合的预防、诊断和治疗措施对降低肺癌发病率、提高生存率有一定意义。

Background and objective Primary lung cancer is one of the most common malignant tumors. The aim of the current study is to retrospectively analyze the clinical features variation of patients with primary bronchogenic carcinoma in West China Hospital Sichuan University to provide information for early detection and treatment of lung cancer. Methods We collected data of patients of permanent population in Sichuan province who diagnosed primary bronchogenic carcinoma in 2000 and 2010 in West China Hospital Sichuan University respectively for comparative analysis of reasons to visit the doctor, duration from symptom onset to visit the doctor, combined diseases, incidences ofbi-primary carcinoma, family history ofma- ,ignanttumor,sites,ftumors,gradeofdi,erentiation,tumorstagingandinitialtreatment modalities.Results A total of 2,167 cases （616 cases in 2000 and 1,551 cases in 2010） met inclusion criteria were retrieved for analysis. In 2010, compared with data of 2000, the rate of patients who visit the doctors because abnormalities were detected by health examination elevated remarkably （5.2% vs 16.7%, P〈0.001）, the duration from symptom onset to visit the doctor abridged significantly （P〈0.001）, patients with family history of malignant tumor increased significantly （3.9% vs 13.7%, P〈0.001）, the constituent ratio of poorly differentiated adenocarcinoma decreased （72.3% vs 51.8%, P--0.002） accompanied with low differentiated squamous cell carcinoma increased （59.4% vs 76.7%, P=0.002）. For NSCLC staging, there is a notably increase of rate of stage Ia （1.0% vs 4.5%, P〈 0.001） and stage IV （30.4% vs 37.8%, P〈0.001） while decrease of stage IIIa （26.6% vs 14.8%, P=0.002）. For initial treatment modalities, there is markedly increased chemotherapy rate of non-small cell lung cancer （NSCLC） patients （41.8%vs 63.4%, P=0.002） while remarkably increased surgery rate of stage Illa patients （41.8% vs 63.4%, P=0.002） and decreased surgery rate of stage IV patients （9.4% vs 3.1%, P=0.001）. The surgery rate of small cell lung cancer （SCLC） patients decrease sharply （30.4% vs 4.3%, P〈0.001）. Conclusion There clinical features of lung cancer patients were significantly changed in the past ten years, new prevention, diagnosis and treatment strategies are needed to accommodate the variation.