老年早期非小细胞肺癌患者胸腔镜术后三年生存率影响因素分析

Factors influencing 3-year survival rate in elderly patients with early non-small cell lung cancer after thoracoscopic surgery

目的分析老年非小细胞肺癌(NSCLC)患者胸腔镜术后生存期影响因素。方法选取2015年2月至2018年2月伊川县人民医院收治的132例行胸腔镜术NSCLC患者,术后随访统计其生存情况,对术后生存期相关因素进行COX回归分析。结果132例NSCLC患者随访8~64个月,一年生存率为89.4%(118/132),三年生存率为78.0%(103/132);胸腔镜术后三年生存、死亡NSCLC患者的病变部位、切除范围、术后病理分期、病理分化、淋巴结转移、查尔森合并症指数(CCI)评分及血管内皮生长因子(VEGF)、活化蛋白-1(AP-1)蛋白阳性比较,差异有统计学意义(P<0.05);COX回归分析显示,病理分化(中/高分化,HR=2.002)、病变部位(中央型,HR=3.916)、切除范围(肺叶切除,HR=1.099)、术后病理分期(Ⅱ期,HR=3.457)、淋巴结转移(HR=5.481)、CCI评分(>5分,HR=3.912)、VEGF(阳性,HR=3.001)、AP-1(阳性,HR=3.112)是老年NSCLC患者胸腔镜术后生存期的预后影响因素(P<0.05)。结论老年NSCLC患者病变部位、切除范围、术后病理分期、病理分化、淋巴结转移、CCI评分及VEGF、AP-1蛋白阳性表达等因素影响其胸腔镜术后生存期,对预后评估、临床干预具有现实指导意义。

Objective To analyze the factors affecting the survival of elderly patients with non-small cell lung cancer(NSCLC)after thoracoscopic surgery.Methods A total of 132 patients with thoracoscopic NSCLC admitted to Yichuan Country People′s Hospital from February 2015 to February 2018 were selected and their survival was counted in the postoperative follow-up,COX regression model was constructed and analyzed for factors related to postoperative survival.Results The 132 patients with NSCLC were followed up for 8-64 months.The 1-year survival rate was 89.4%(118/132)and the 3-year survival rate was 78.0%(103/132).A statistically significant difference(P<0.05)between survival at 3 years after thoracoscopy and death in patients with NSCLC in terms of lesion site,extent of resection,postoperative pathological stage,pathological differentiation,lymph node metastasis,Charlson Comorbidity Index(CCI)score and positivity for vascular endothelial growth factor(VEGF)and activated protein-1(AP-1)protein.COX regression model analysis showed that pathological differentiation(medium/high differentiation,HR=2.002),lesion site(central type,HR=3.916),resection scope(lobotomy,HR=1.099),postoperative pathological stage(stageⅡ,HR=3.457),lymph node metastasis(HR=5.481),CCI score(>5,HR=3.912),VEGF(positive,HR=3.001)and AP-1(positive,HR=3.112)were prognostic factors for survival of elderly patients with NSCLC after thoracoscopic surgery(P<0.05).Conclusion Factors such as lesion site,extent of resection,postoperative pathological staging,pathological differentiation,lymph node metastasis,CCI score and positive expression of VEGF and AP-1 protein in elderly NSCLC patients affect their survival after thoracoscopy surgery,which has practical guiding significance for prognosis assessment and clinical intervention.