肺癌患者1168例首程诊治临床分析

Clinical analysis of 1168 cases of patients with lung cancer for the first diagnosis and therapy

目的研究肺癌患者首次诊治的临床症状、就诊时间、分期、治疗及预后。方法回顾性分析2009年1168例首次在山东省肿瘤医院诊治的肺癌患者的临床特点,其中男828例、女340例;最大年龄88岁,最小年龄19岁;平均年龄60.16岁,中位年龄60岁。主要症状:咳嗽、咳痰、痰中带血、胸痛、胸闷、憋喘、发热及肺外症状。就诊时间:最短3 d,最长24个月,平均时间2.29个月,中位时间2个月。病理或细胞学类型:腺癌、鳞癌、小细胞癌、腺鳞癌及其他类型癌分别为621例(53.2%)、337例(28.8%)、143例(12.2%)、18例(1.5%)、49例(4.2%);临床分期Ⅰ、Ⅱ、ⅢA、ⅢB、Ⅳ分别为46例(3.9%)、85例(7.3%)、270例(23.0%)、228例(19.6%)、539例(46.1%)。采用Kaplan-Meier法进行生存分析,多因素Cox回归分析。结果随访率为92.4%,1年、2年、3年生存率分别为80.4%、44.9%、15.8%;多因素分析表明患者的年龄、肿瘤T分期、淋巴结N分期、临床分期及治疗方式是影响生存的独立危险因素。结论肺癌症状不典型,就诊时间较晚,就诊时临床分期较晚,预后较差,患者的年龄、肿瘤T分期、淋巴结N分期、临床分期及治疗方式是影响生存的独立危险因素。

Objective To study the clinical symptoms,diagnosis,staging,therapy and prognosis of patients with lung cancer for the first time .Methods To analyse the clinical characteristics of 1168 cases of patients with lung cancer retrospectively in 2009 in Shandong Cancer Hospital for the first time .The male was 828 cases and the female was 340 cases.The age was from 19 to 88 years old.The average age was 60.16 years and the median age was 60 years.The Main symptoms were cough,sputum,bloody sputum,chest pain,chest tightness,dyspnea,fever and extrapulmonary symptoms.The period of time for the patients to see doctors was from 3 days to 24 months,and the average time was 2.29 months and the median time was 2 months.Pathological or cytological types：adenocarcinoma , squamous carcinoma,small cell carcinoma,adenosquamous carcinoma and other types were 621 cases（53.2%）,337 cases（28.8%）,143 cases（12.2%）,18 cases（1.5%）and 49 cases（4.2%）,respectively.Clinical stagingⅠ,Ⅱ,ⅢA,ⅢB and Ⅳwere respectively 46 cases（3.9%）,85 cases（7.3%）,270 cases（23.0%）,228 cases（19.6%） and 539 cases（46.1%）.The patients were followed up until death or the cut-off date.Kaplan-Meier method of survival analysis and multivariate Cox regression analysis were used to determine the clinical risk factors and evaluate their influence on the survival .Results The follow-up rate was 92.4%, and the one-year, two-year, three-years survival rate were 80.4%,44.9%,15.8%.Multi-factor analysis revealed that the patient′s age,tumor T stage,lymph node N stage,clinical stage and the methods of therapy were independent risk factors for survival .Conclusion The symptoms of patients with lung cancer are not typical .The prognosis is poor since the diagnosis is too late and the clinical stage is relatively late.The patient′s age,tumor T stage,lymph node N stage,clinical stage and the methods of therapy are independent risk factors for survival .