556例非手术男性肺癌预后分析  

Analysis on prognosis in 556 male cases of unoperated lung cancer

作　　者：杜佳[1] 肖何[1] 许明芳[1] 孟昊[1] 岳渝 谢家印[1] 王东[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肿瘤中心,重庆400042

出　　处：《检验医学与临床》2017年第7期939-943,947,共6页Laboratory Medicine and Clinic

摘　　要：目的探讨男性肺癌患者的临床病理特征及治疗效果,分析影响患者预后的因素,为男性肺癌的个体化分层治疗提供依据。方法回顾性分析经病理证实非手术治疗的男性肺癌556例,分析年龄、病理类型、表皮生长因子受体(EGFR)突变情况、TNM分期、接受治疗情况、一线治疗效果及无进展生存期(PFS)、总生存时间(OS)等。结果患者年龄35~87岁,中位年龄60岁,平均(60.57±9.82)岁,以50~69岁居多,占67.81%(377/556)。确诊方式主要以经皮肺穿刺及纤支镜活检为主,占84.63%(479/556);非小细胞肺癌占77.70%(432/556),病理类型中腺癌占38.67%,鳞癌占32.55%;EGFR突变检测158例,突变型占21.52%(34/158)。TNM分期中早期非小细胞肺癌(ⅠA~ⅢA期)占26.16%,晚期非小细胞肺癌(ⅢB~Ⅳ期)占73.84%;566例患者中,32例放弃治疗,265例只进行一线治疗,184例完成二线治疗,75例完成三线及更多线治疗。一线治疗后可评估患者399例,客观缓解率(ORR)为17.79%,疾病控制率(DCR)为51.88%。中位PFS 9个月,中位OS 14个月。随访时间1年及以上患者共301例,其中56例患者死亡;1年生存率为64.12%(193/301),2年生存率为18.94%(57/301)。一线治疗中,酪氨酸激酶抑制剂(TKI)药物治疗的ORR显著高于化疗和放疗,差异有统计学意义(P<0.05);多变量Cox回归表明,客观缓解是PFS的独立预后因素;治疗线数与OS相关,接受二线、三线及以上治疗的患者OS显著延长,而年龄、分期、EGFR突变情况、组织学类型、治疗方案和效果均不是OS的独立预后因素。结论男性肺癌发病以中老年居多,非小细胞肺癌为主,病理类型中腺癌与鳞癌无差异,EGFR突变率较低,TKI一线治疗的ORR高于化疗和放疗,一线治疗后达到客观缓解的患者PFS显著延长,接受二线及以上治疗的患者比仅接受一线治疗或未治疗的患者预后更好。Objective To describe the clinicopathological features and treatment effect of male patients with lung cancer,and to analyze the factors affecting prognosis to provide reference for and the personalized gradation treatment of male lung cancer.Methods A total of 556 male patients with unoperated lung cancer were retrospective analyzed,including the age,pathological type,EGFR mutations situation,TNM staging,treatment,first-line treatment effect,progression-free survival（PFS）and overall survival（OS）.Results The patients aged 35-87 years old,the median age was 60 years old,the average was（60.57±9.82）years old,the majority were 50-69 years old,accounting for 67.81%（377/556）.The definite diagnosis pattern was dominated by percutaneous transthoracic needle biopsy and bronchoscopy（84.63%）;non-small-cell lung cancer accounted for 77.70%（432/556）;adenocarcinoma in pathological types accounted for 38.67%,squamous carcinoma accounted for 32.55%;34cases were EGFR mutation,accounting for 21.52%（34/158）.TNM ⅠA—ⅢA accounted for 26.16%,TNM ⅢB—Ⅳ accounted for 73.84%.Of all cases,32 cases gave up treatment,265 cases underwent only the first-line treatment,184 cases accomplished the second-line treatment,75 cases completed the third-liner/and advanced treatment.There were evaluable 399 cases after the first-line treatment,the objective remission rate（ORR）was 17.79%,and the disease control rate（DCR）was 51.88%.The median PFS was 9months,the median OS was14 months.301cases were followed up for 1year or more,in which 56 cases died.the 1-year survival rate was 64.12%（193/301）,and 2-years survival rate was 18.94%（57/301）.ORR of TKI in the first-line treatment was significantly higher than that of chemotherapy and radiotherapy,the difference was statistically significant（P〈0.05）.The multivariate Cox regression analysis indicated that the objective remission was the independent prognosis factor of PFS;the treatment line number was related with OS,OS of patients receiving the sec

关 键 词：肺癌 男性 临床特征 治疗 预后 

分 类 号：R734.2[医药卫生—肿瘤]