性别、吸烟状态及病理类型对肺癌患者化学治疗和手术预后的影响  

Effects of gender,smoking status,and pathologic type on the prognosis of chemotherapy and surgery in patients with lung cancer

作　　者：钟文昭[1] 李巍[1] 黄劭洪[2] 廖日强[1] 

机构地区：[1]广东省人民医院肿瘤中心肺二科,广州510080 [2]中山大学附属第三医院胸外科,广州510630

出　　处：《新医学》2015年第7期433-438,共6页Journal of New Medicine

基　　金：国家自然科学基金面上项目(81372285)

摘　　要：目的评估性别、吸烟状态、病理类型对肺癌患者化学治疗和手术预后的影响。方法收集一组连续性5年肺癌病例。初诊时建立前瞻性设计的电子病历和随访表。从性别、吸烟状态、病理类型3个方面评估不同亚组对化学治疗毒性、疗效、术后并发症、无瘤生存期(DFS)和总体生存期(OS)的差异。结果研究共纳入616例肺癌患者,女性以非吸烟腺癌为主,男性以吸烟鳞癌为主。男性化学治疗非血液学毒性低于女性(P<0.05);男性术后并发症多于女性(P<0.05);吸烟者术后并发症多于非吸烟者(P<0.05)。非吸烟、女性、腺癌和其对立面在化学治疗毒性、化学治疗效果、手术完全切除率、术后并发症等均未见明显差异(P>0.05)。单因素生存分析显示,腺癌的中位DFS长于非腺癌(23.7个月vs.11.4个月,P<0.05);女性、非吸烟和腺癌根治术预后优于男性、吸烟和非腺癌(中位OS 52.8个月vs.33.1个月,P<0.05;52.2个月vs.33.1个月,P<0.01;43.9个月vs.20.4个月,P<0.01),非吸烟腺癌的DFS和OS均明显优于吸烟非腺癌(P均<0.05)。结论性别、吸烟状态、病理类型对肺癌患者的化学治疗毒性反应、化学治疗效果评价、手术完全切除率和术后并发症无明显影响,但女性、非吸烟、腺癌的手术预后明显优于男性、吸烟、非腺癌,这种优势在非吸烟腺癌中尤为明显。Objective To evaluate the effects of gender, smoking status, and pathologic type on the prognosis of chemotherapy and surgery in patients with lung cancer. Methods A cohort of consecutive patients over a period of five years with non-small cell lung cancer （NSCLC） was included. Electronic medical records and follow-up forms were developed using a prospective design at the initial diagnosis. The differences between the subgroups of patients （ gender, smoking status, and pathological type） were assessed with regard to chemotherapeutic toxicity and responses, complete resection and postoperative complication rates, and disease-free survival （DFS） and overall survival （OS） periods. Results In total 616 NSCLC patients were included; Nonsmoking female showed a higher incidence of adenocarcinoma （ ADC）, and smoking male showed a higher incidence of squamous cell carcinoma （SCC）. The non-hematologic toxicity induced by chemotherapy was milder in males than in females （P 〈 0. 05 ）, and the postoperative complication rate was higher in males than in females （ P 〈 0. 05 ）. Smokers exhibited a higher postoperative complication rate than non-smokers （ P 〈 0.05 ） . No significant differences between smokers and non-smokers, males and females, or ADC and SCC patients were observed regarding chemotherapeutic toxicity and responses or the complete resection and postoperative complication rates （P 〉 0. 05 ）. The median DFS of ADC patients was shorter than that of non-ADC patients （23.7 months vs. 11.4 months, P 〈 0. 05 ）. The prognosis of lung ADC in female non-smokers was better than that of non-ADC in male smokers after a thoracotomy （median OS 52. 8 months vs. 33.1 months for gender, P 〈0.05 ; 52. 2 months vs. 33.1 months for smoking status, P 〈 0. 01 ; and 43.9 months vs. 20.4 months for pathological type, P 〈0.01, respectively）. Both the DFS and OS of non-smokers with ADC were significantly longer than those of smokers with non-ADC （P 〈 0. 05）. Conclusions

关 键 词：非小细胞肺癌 非吸烟肺癌 自然病程 

分 类 号：R734.2[医药卫生—肿瘤]