539例Ⅳ期肺癌患者首程诊治临床分析

Clinical Investigation into the Initial Diagnosis and Treatment of 539 Patients with Ⅳ Stage Lung Cancer

目的研究Ⅳ期肺癌患者首程诊治的临床症状、病理分型、转移器官、治疗方法及生存时间等临床特征。方法回顾性分析2009年539例首次诊治Ⅳ期肺癌患者的临床特征,其中男351例(65.1%)、女188例(34.9%);最大年龄88岁,最小年龄19岁;平均年龄58.51岁,中位年龄59岁,60岁以下282例(52.3%)。主要症状:咳嗽、咳痰、痰中带血、胸痛、胸闷、憋喘、发热及肺外症状如头痛、骨痛等。细胞学和/或病理类型:腺癌、鳞癌、小细胞癌、大细胞癌、腺鳞癌及其他类型癌分别为377例(69.9%)、95例(17.6%)、50例(9.3%)、9例(1.7%)、5例(0.9%)及3例(0.6%);其中单器官、多器官转移分别为393例(72.9%)、146例(27.1%);单器官转移中,胸膜、脑、骨、肺、肝、肾上腺转移分别为112例(28.5%)、100例(25.4%)、78例(19.8%)、60例(15.3%)、29例(7.4%)、14例(3.6%)。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85.3%,1年、2年、3年生存率分别为64.2%(346例)、19.7%(106例)、1.5%(8例);肝脏及胸膜转移预后较差,骨转移预后相对较好;多器官转移较单器官转移预后差;多因素分析表明患者的年龄、不同转移器官、转移器官数目及治疗方式是影响生存的独立危险因素。结论Ⅳ期肺癌患者临床症状多样,无特异性,预后较差,患者的年龄、远处转移部位、转移器官数目及治疗方式是影响生存的主要因素。

Objective The aim of the present study was to analyse clinical data obtained from patients with IV stage lung cancer, including the initial clinical symptoms upon diagnosis, the types of pathological classification, transferred organs, treatment strategy and prognosis. Methods A retrospective analysis was conducted of the clinical features of 539 lung cancer patients（ IV stage） who were initially diagnosed and treated at Shandong Cancer Hospital and Institute （Jinan, China） in 2009. the clinical features of 539 cases of patients, including male 351 cases （65.1% ）, female 188 cases （ 34.9% ）. The maximum and minimum age were 88 and 19 years old, respectively. The average age was 58.51and the median age was 59, but the age less than 60 years old was 282 cases （52.3%）. The main symptoms were cough, sputum, blood in phlegm, chest pain, chest tightness, holding breath, fever and extrapulmonary symptoms. The types of cytology and/or pathological such as adenocarcinoma, squamous carcinoma, small cell carcinoma, large cell carcinoma, adenosquamous carcinoma and other types were respectively 377 cases （69.9%）, 95 cases （ 17.6% ）, 50 cases （9.3%）, 9 cases （ 1.7% ）, 5 cases （0.9%） and 3 cases （0.6%）. The metastases from one single organ and muhiple organs were 393 cases （72.9%）, 146 cases （27.1%）, respectively. Single organ metastasis such as pleura, brain, bone, lung, liver, adrenal metastasis is respectively 112 cases （28.5%）, 100 cases （25.4%）, 78 cases （19.8%）, 60 cases （15.3%）, 29 cases （7.4%）, 14 cases （3.6%）. The Kaplan Meier method and multivariate Cox regression analysis were performed to analyse the influence of age, predominant symptoms, pathological classification, transferred organs, treatment strategy on patient- overall survival. Results The 1 , 2 and 3 year survival rates were 64.2% （346 cases）, 19.7% （ 106 cases） and 1.5% （8 cases） ,respectively. The metastases of liver and pleura were poor prognosis, but the bone metastases were relatively well. Multi - factor analysis showed that the patient age, different metastatic organs, The number of metastatic organs and treatment were independent risk factors on survival. Conclusion The clinical symptoms of patients with IV stage lung cancer are diversiform and have no specificity. The prognosis is poor. The patient＇s age, different metastatic organs, the number of metastatic organs, and treatment affect patientg survival.