老年肺鳞癌患者的临床特征及预后影响因素分析  

Clinical characteristics of elderly patients with squamous cell lung cancer and prognostic factors

作　　者：王婕 张甜甜 崔海琳 崔童 霍树芬[2] 孙莉[2] 田应选[2] Wang Jie;Zhang Tiantian;Cui Hailin;Cui Tong;Huo Shufen;Sun Li;Tian Yingxuan(Graduate School of Xi′an Medical University,Xi′an 710021,China;Department of Geriatric Respiratory Medicine,Shaanxi Provincial People′s Hospital,Xi′an 710068,China)

机构地区：[1]西安医学院研究生院,西安710021 [2]陕西省人民医院老年呼吸科,西安710068

出　　处：《国际呼吸杂志》2023年第7期803-809,共7页International Journal of Respiration

基　　金：陕西省科技厅自然科学重点研究项目(2022JZ-59);陕西省人民医院拔尖人才支持计划(2021BJ-22)。

摘　　要：目的研究老年肺鳞癌患者的临床特征及其预后的影响因素。方法本研究为队列研究,采用非随机抽样的方法选取2016年1月至2021年2月陕西省人民医院收治的90例老年肺鳞癌患者为研究对象。通过电话随访、门诊随访、住院随访的方式,收集患者的性别、年龄、吸烟情况、病理标本取材方式、体力活动状态(PS)评分、合并慢性疾病个数、临床分期和治疗方式。随访时间截至2021年10月15日。通过Kaplan-Meier法估计生存曲线,并采用Log-rank检验比较不同临床特征老年肺鳞癌患者的生存曲线,采用多因素Cox回归模型分析老年肺鳞癌患者预后的影响因素。结果共纳入90例老年肺鳞癌患者,其中男82例(91.1%),女8例(8.9%);60~69岁48例(53.3%),≥70岁42例(46.7%);吸烟74例(82.2%),不吸烟16例(17.8%);经支气管镜取材79例(87.8%),经皮穿刺取材11例(12.2%);PS评分0分15例(16.7%),1分51例(56.7%),2分16例(17.8%),3分6例(6.7%),4分2例(2.2%);合并慢性疾病<2个41例(45.6%),≥2个49例(54.4%);临床分期Ⅰ期17例(18.9%),Ⅱ期18例(20.0%),Ⅲ期29例(32.2%),Ⅳ期26例(28.9%);手术15例(16.7%),化疗43例(47.8%),手术联合化疗32例(35.6%)。截至随访终止,死亡83例(92.2%),生存7例(7.8%),中位生存期为16.0个月(95%CI:11.3~20.6)。男性患者的生存状态优于女性患者(χ^(2)=12.51,P=0.001);60~69岁患者的生存状态优于≥70岁患者(χ^(2)=5.13,P=0.023);吸烟患者的生存状态较不吸烟患者好(χ^(2)=5.00,P=0.025);PS评分0分患者的生存状态较3分患者、4分患者好(χ^(2)值分别为4.43、20.40,均P<0.05),1分患者的生存状态较2分患者、3分患者、4分患者好(χ^(2)值分别为4.24、5.56、26.10,均P<0.05);临床分期Ⅰ期患者的生存状态优于Ⅲ期、Ⅳ期患者(χ^(2)值分别为6.96、15.31,均P<0.01),Ⅱ期患者的生存状态优于Ⅲ期、Ⅳ期患者(χ^(2)值分别为4.62、15.14,均P<0.05),Ⅲ期患者的生存状态优于Ⅳ期患者(χ^(2)=4.02,P=0.045);手Objective To analyze the clinical characteristics of elderly patients with squamous cell lung cancer and the prognostic factors.Methods It was a cohort study involving 90 elderly patients with squamous cell lung cancer treated in Shaanxi Provincial People′s Hospital from January 2016 to February 2021 using the non-random sampling method.Through the telephone follow-up,outpatient follow-up,and inpatient follow-up,patients′gender,age,smoking status,pathology specimen sampling method,performance status(PS)score,number of combined with chronic diseases,clinical stage,and treatment modality were recorded.Follow-up ended on October 15,2021.Kaplan-Meier method was performed to estimate the survival curves,followed by the Log-rank test to compare the survival curves of elderly patients with squamous cell lung cancer presenting different clinical characteristics.Multivariable Cox regression model was introduced to analyze the prognostic factors for elderly patients with squamous cell lung cancer.Results A total of 90 elderly patients with squamous cell lung cancer were included,involving 82(91.1%)males and 8(8.9%)females.Among them,48(53.3%)patients were older than 60 years or above but younger than 70 years,and 42(46.7%)were older than 70 years or above.There were 74(82.2%)smokers and 16(17.8%)non-smokers.Transbronchial microscopic samples and percutaneous puncture samples were collected from 79(87.8%)and 11(12.2%)patients,respectively.Based on the PS score,15(16.7%),51(56.7%),16(17.8%),6(6.7%),and 2(2.2%)patients were graded 0,1,2,3,4 points,respectively.41(45.6%)patients combined with less than 2 chronic diseases,and 49(54.4%)combined 2 or more.There were 17(18.9%),18(20.0%),29(32.2%)and 26(28.9%)cases of stageⅠ,Ⅱ,ⅢandⅣ,respectively.15(16.7%)patients were surgically treated,and 43(47.8%)were treated with chemotherapy,and the remaining 32(35.6%)patients were treated with both.By the end of follow-up,there were 83 deaths(92.2%)and 7 survivals(7.8%),with the median survival time of 16.0 months(95%CI:11.3-20.6)

关 键 词：肺肿瘤 老年人 预后 生存分析 

分 类 号：R734.2[医药卫生—肿瘤]