辽宁省城市肺癌患者10年生存率及其影响因素分析

Analysis of 10-year survival rate and its influencing factors among urban patients with lung cancer in Liaoning Province

目的分析辽宁省城市肺癌患者的10年生存率及其影响因素,为肺癌防治策略的制订提供参考依据。方法采用分层随机抽样方法从辽宁省2000年肿瘤发病报告数据库中抽取了沈阳、鞍山和本溪3个市共483例肺癌患者,并采用主动结合被动随访的方式回顾性调查患者的基本情况、临床信息和生存状况;采用寿命表法计算观察生存率(OSR)和中位生存期(median survival time,T_(50)),应用EdererⅡ方法计算期望生存率(ESR)和相对生存率(RSR),并应用Cox回归模型分析生存影响因素。结果辽宁省不同特征城市肺癌患者10年生存率比较,诊断分期为Ⅱ期、Ⅲ期、Ⅳ期的肺癌患者10年OSR、RSR和T_(50)均低于诊断分期为Ⅰ期的肺癌患者(均P<0.05),年龄≥65岁肺癌患者的10年T_(50)低于<65岁肺癌患者(χ^(2)=10.043,P=0.002),非手术治疗肺癌患者的10年T_(50)低于手术治疗肺癌患者(χ^(2)=35.715,P<0.001)。多因素Cox回归分析结果显示,年龄每增加1岁,辽宁省城市肺癌患者的相对死亡风险增加0.015倍(HR=1.015,95%CI:1.004~1.026);诊断分期为Ⅱ期、Ⅲ期和Ⅳ期肺癌患者的相对死亡风险为Ⅰ期肺癌患者的2.794倍(HR=2.794,95%CI:1.710~4.564)、2.286倍(HR=2.286,95%CI:1.599~3.270)和3.995倍(HR=3.995,95%CI:2.855~5.590)。结论辽宁省2000年城市肺癌患者10年生存率明显低于发达国家同期水平,早期诊断和治疗率低可能是主要原因。

Objective To analyze the 10-year survival rate and its influencing factors among urban patients with lung cancer in Liaoning Province,and to provide a reference basis for formulating lung cancer prevention and treatment strategy.Methods A total of 483 lung cancer patients from Shenyang,Anshan and Benxi were selected by stratified random sampling from cancer incidence report database of Liaoning Province in 2000.General information,clinical information and survival status of the patients were retrospectively investigated by active and passive follow-up.The overall survival rate(OSR)and median survival time(T_(50))were calculated by life table method.The expected survival rate(ESR)and relative survival rate(RSR)were calculated by Ederer Ⅱ method,and factors influencing the survival were analyzed by Cox regression model.Results The 10-year survival rates of the lung cancer patients from different characteristic cities in Liaoning Province were compared.The 10-year OSR,RSR and T_(50)of patients diagnosed with stage Ⅱ,Ⅲ and Ⅳ lung cancer were all lower than those of patients diagnosed with stage Ⅰ lung cancer(all P<0.05).The 10-year T_(50)of lung cancer patients aged≥65 years was lower than that of lung cancer patients aged<65 years(χ^(2)=10.043,P=0.002),and the 10-year T_(50)of non-operative lung cancer patients was lower than that of operative lung cancer patients(χ^(2)=35.715,P<0.001).Multivariate Cox regression analysis showed that the relative mortality risk of the urban patients with lung cancer increased by 0.015 times(HR=1.015,95%CI=1.004-1.026)for every one-year increase in age.The relative risks of death of patients with stage II,III and IV lung cancer were 2.794(HR=2.794,95%CI=1.710-4.564),2.286(HR=2.286,95%CI=1.599-3.270)and 3.995(HR=3.995,95%CI=2.855-5.590)times that of patients with stage I lung cancer.Conclusion The 10-year survival rate of the lung cancer patients in Liaoning Province in 2000 was significantly lower than that in developed countries.The low rates of early diagnosis and treatment may be the main cause.