≤40岁肺癌患者109例临床病理特点及预后分析

Clinicopathological characteristics and prognosis of 109 patients with lung cancer aged 40 years or less

目的随着吸烟和环境因素的影响,世界各国特别是工业发达国家,肺癌发病率和病死率均迅速上升,位于全世界癌症死因的第1位。本研究探讨≤40岁肺癌患者临床病理特征、表皮生长因子受体(epidermal growth factor receptor, EGFR)基因突变率及预后影响因素,为青年肺癌患者的诊断及治疗提供理论依据。方法回顾性收集2012-01-01-2015-12-31新疆医科大学附属肿瘤医院109例≤40岁肺癌患者的临床资料,采用Log-rank检验进行单因素分析,Cox回归模型进行多因素分析,将影响总生存期独立危险因素按EGFR是否突变进行分层,采用Kaplan-Meier法进行生存分析。结果 109例≤40岁肺癌患者,男女比例为1 : 1.2,平均确诊时间63 d,误诊60例,误诊率高达55%;病理类型以腺癌为主(83%);EGFR基因突变率高(65. 2%);Cox多因素分析表明,临床分期(HR = 6. 746,95% CI: 2. 587~17. 597)与EGFR突变状态(HR= 1. 504,95%CI: 1. 188~1. 902)是青年肺癌独立预后因素,EGFR突变阳性患者中位生存期(29个月)长于阴性患者(15个月),差异有统计学意义,X^2= 19. 93,P<0. 001。结论≤40岁肺癌患者中女性比例高、腺癌比例高、误诊率高、预后差,早期筛查可能是最主要的防治措施,基于分子特征的靶向治疗将改善青年肺癌患者的疗效和生存期。

OBJECTIVE With the influence of smoking and environmental factors, the incidence and mortality of lung cancer have risen rapidly all over the world, especially in industrialized countries, ranking the first cause of cancer death in the world. The aim of this study was to investigate the clinical and pathological characteristics, the mutation rate of epidermal growth factor receptor(EGFR) gene and the prognostic factors of lung cancer patients aged 40 years or less, so as to provide a theoretical basis for the diagnosis and treatment of young lung cancer patients. METHODS Clinical data of 109 lung cancer patients aged 40 years or less in Tumor Hospital Affiliated to Xinjiang Medical University from January 1st,2012 to December 31st,2015 were retrospectively collected. Log-rank test was used for univariate analysis and Cox regression model was used for multivariate analysis. The independent risk factors affecting overall survival(OS) were stratified according to whether EGFR was mutant. Kaplan-Meier method was used for survival analysis. RESULTS Among 109 lung cancer patients aged 40 years or less, the ratio of male to female was 1 : 1. 2, the average time of diagnosis was 63 days,and 60 cases were misdiagnosed, the misdiagnosis rate was as high as 55%. The main pathological types were adenocarcinoma(83%). The mutation rate of EGFR gene was high(65. 2%). Cox multivariate analysis showed that clinical stage(HR = 6. 746,95%CI:2. 587-17. 597) and mutation status of EGFR(HR= 1. 504,95%C7: 1. 188 -1. 902) were independent prognostic factors for young lung cancer. The median survival period of EGFR mutation positive patients (29 months) was longer than that of negative patients( 15 months), the difference was statistically significant(X^2 =19. 93, P<0. 001). CONCLUSIONS Among lung cancer patients aged 40 years old,the proportion of women is high,the proportion of adenocarcinoma is high,the misdiagnosis rate is high,and the prognosis is poor. Early screening may be the most important prevention and treatment measure,and targeted therapy based on molecular characteristics will improve the efficacy and survival of young lung cancer patients.