基于年龄、远端转移情况、病理学分型分析非小细胞肺癌患者的预后

Analysis of Prognosis of Patients with Non-small Cell Lung Cancer Based on Age,Distant Metastasis and Pathological Type

背景肺癌是全球死亡率最高的恶性肿瘤,预后较差,而年龄、远端转移情况、病理学分型与肺癌患者预后均有密切关系。原发性肺癌以非小细胞肺癌(NSCLC)为主,目前通过大样本量数据分析年龄、远端转移情况、病理学分型与NSCLC患者预后关系的研究较少。目的基于年龄、远端转移情况、病理学分型分析NSCLC患者的预后,以期为临床诊疗NSCLC提供参考依据。方法回顾性选取2015—2020年沧州市中心医院肿瘤科、呼吸科、心胸外科收治的NSCLC患者23731例为研究对象。收集患者临床资料,统计患者预后指标。NSCLC患者预后影响因素分析采用多因素Cox回归分析;利用Graphpad Prsim软件、采用Kaplan-Meier法绘制生存曲线,生存曲线间的比较采用Logrank检验。结果23731例患者中,最终死亡18231例(76.82%),其中15927例死于肺癌。多因素Cox回归分析结果显示,<50岁、50~65岁、M分期、外科手术、仅脑转移、仅淋巴结转移、鳞癌是NSCLC患者预后的影响因素(P<0.05)。<50岁患者7年累积生存率高于50~65岁、>65岁患者(P<0.05);50~65岁患者7年累积生存率高于>65岁患者(P<0.05)。仅骨转移患者7年累积生存率低于仅脑转移、仅肺转移、仅淋巴结转移患者,高于仅肝转移患者(P<0.05);仅脑转移患者7年累积生存率高于仅肝转移患者(P<0.05);仅肝转移患者7年累积生存率低于仅肺转移、仅淋巴结转移患者(P<0.05)。腺癌患者7年累积生存率高于鳞癌、大细胞癌患者(P<0.05);鳞癌患者7年累积生存率高于大细胞癌患者(P<0.05)。结论NSCLC患者预后的影响因素众多,包括<50岁、50~65岁、M分期、外科手术、仅脑转移、仅淋巴结转移、鳞癌。<50岁患者预后最好,其次是50~65岁患者,>60岁患者预后最差;仅脑转移、仅肺转移、仅淋巴结转移患者预后较好,其次是仅骨转移患者,仅肝转移患者预后最差;腺癌患者预后最好,其次是鳞癌患者,大细胞癌患者预后最差。

Background Lung cancer is the malignant tumor with the highest mortality in the world,and its prognosis is poor.Age,distant metastasis and pathological type are closely related to the prognosis of lung cancer patients.Primary lung cancer is mainly non-small cell lung cancer(NSCLC).At present,there are few studies on the relationship between age,distant metastasis,pathological type and prognosis of NSCLC patients.Objective To analyze the prognosis of NSCLC patients based on age,distant metastasis and pathological type,in order to provide reference basis for clinical diagnosis and treatment of NSCLC.Methods A total of 23731 patients with NSCLC treated in the Oncology Department,Respiratory Department and Cardiothoracic Surgery Department of Cangzhou Central Hospital from 2015 to 2020 were retrospectively selected as the research objects.The clinical data of patients were collected and the prognostic indexes were counted.Multivariate Cox regression analysis was used to analyze the prognostic factors of NSCLC patients.The survival curve was drawn by Graphpad Prsim software and Kaplan-Meier method.The comparison between survival curves was tested by Log-rank test.Results Among the 23731 patients,18231(76.82%)died,of which 15927 died of lung cancer.Multivariate Cox regression analysis showed that<50 years old,50-65 years old,M stage,surgery,brain metastasis only,lymph node metastasis only and squamous cell carcinoma were the prognostic factors of NSCLC patients(P<0.05).The 7-year cumulative survival rate of patients aged<50 years old was higher than that of patients aged 50-65 years old and>65 years old(P<0.05).The 7-year cumulative survival rate of patients aged 50-65 years old was higher than that of patients aged>65 years old(P<0.05).The 7-year cumulative survival rate of patients with bone metastasis only was lower than that of patients with brain metastasis only,lung metastasis only and lymph node metastasis only,and higher than that of patients with liver metastasis only(P<0.05).The 7-year cumulative survival rate of patients with brain metastasis only was higher than that of patients with liver metastasis only(P<0.05).The 7-year cumulative survival rate of patients with liver metastasis only was lower than that of patients with lung metastasis only and lymph node metastasis only(P<0.05).The 7-year cumulative survival rate of patients with adenocarcinoma was higher than that of patients with squamous cell carcinoma and large cell carcinoma(P<0.05).The 7-year cumulative survival rate of patients with squamous cell carcinoma was higher than that of patients with large cell carcinoma(P<0.05).Conclusion There are many factors affecting the prognosis of patients with NSCLC,including<50 years old,50-65 years old,M stage,surgery,brain metastasis only,lymph node metastasis only and squamous cell carcinoma.The prognosis of patients aged<50 years old is the best,followed by patients aged 50-65 years old,and patients aged>60 years old have the worst prognosis;the prognosis of patients with brain metastasis only,lung metastasis only and lymph node metastasis only is better,followed by patients with bone metastasis only,and patients with liver metastasis only have the worst prognosis;patients with adenocarcinoma have the best prognosis,followed by patients with squamous cell carcinoma,and patients with large cell carcinoma have the worst prognosis.