肺腺鳞癌患者预后影响因素分析  

Analysis of prognostic factors in patients with lung adenosquamous carcinoma

作　　者：王秋桐[1] 陈玲[1] 杨艳梅[1] 王明[2] 吴爽[1] 安跃震 姜俊杰 赵瑞[5] WANG Qiutong;CHEN Ling;YANG Yanmei;WANG Ming;WU Shuang;AN Yuezhen;JIANG Junjie;ZHAO Rui(Cangzhou Medical College,Hebei Cangzhou 061001,China;Department of Oncology,Cangzhou Central Hospital,Hebei Cangzhou 061001,China;Department of Laboratory,Cangzhou Central Hospital,Hebei Cangzhou 061001,China;Department of Thyroid and Mammary Surgery,Cangzhou Central Hospital,Hebei Cangzhou 061001,China;Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China.)

机构地区：[1]沧州医学高等专科学校,河北沧州061001 [2]沧州市中心医院肿瘤科,河北沧州061001 [3]沧州市中心医院检验科,河北沧州061001 [4]沧州市中心医院甲乳外科,河北沧州061001 [5]首都医科大学附属北京朝阳医院,北京100020

出　　处：《现代肿瘤医学》2024年第6期1048-1054,共7页Journal of Modern Oncology

基　　金：河北省沧州市重点研发计划指导项目(编号:213106072)。

摘　　要：目的:探讨肺腺鳞癌(ASC)患者预后影响因素并建立列线图模型。方法:回顾性分析2009年1月-2020年1月沧州市中心医院ASC患者临床资料。Kaplan-Meier法进行单因素分析,生存差异采用Log-Rank检验,COX回归分析筛选ASC癌患者预后独立影响因子,评价其生存差异和建立模型。结果:149例患者总mOS为17.7个月。多因素分析结果显示手术、化疗、联合治疗、瘤周有炎症变化、脑转移是预后的独立影响因子。亚组分析结果显示,手术组mOS高于未手术组(P<0.001);化疗组mOS高于未化疗组(P=0.005);联合治疗组mOS高于未联合治疗组(P=0.002),瘤周无炎症变化组mOS高于瘤周有炎症变化组(P=0.013),脑转移组mOS低于无脑转移组(P<0.001),高风险组(≥3分)mOS高于低风险组(<3分)(P=0.054)。基于上述5个因子构建的列线图模型预测患者生存的准确度为0.752(AUC=0.752,95%CI:0.659~0.845),模型预测患者生存率与实际生存率的一致性较高。结论:ASC整体预后差。瘤周炎症变化、脑转移、手术、化疗、联合治疗是ASC预后的独立影响因子,基于此建立的预测模型可辅助ASC患者临床诊疗与预后判断。Objective:To explore the clinical prognostic factors of ASC lung cancer patients and construct the nomograph model.Methods:The clinical data of ASC lung cancer patients who were discharged from Cangzhou Central Hospital from January 2009 to January 2020 were retrospectively analyzed.Univariate and multivariate Cox regression analysis was used to determine the prognostic factors,evaluate the survival difference of each prognostic factor and construct the nomogram model.Results:The mOS of the 149 patients was 17.7months.The results of multivariate analysis showed that surgical,chemotherapy,combined therapy,brain metastasis and inflammatory changes surrounding the tumor were independent prognostic factors in patients with lung adenosquamous carcinoma.The results of subgroup analysis showed that the mOS in surgical group were significantly higher than no surgical group(P<0.001),the mOS in chemotherapy group were significantly higher than no chemotherapy group(P=0.005),the mOS in combined therapy group were significantly higher than no combined therapy group(P=0.002),the mOS in the inflammatory changes surrounding the tumor group was significantly lower than inflammatory no changes surrounding the tumor group(P=0.013),the mOS in brain metastasis group were significantly lower than no brain metastasis group(P<0.001),the mOS of high risk group(≥3 points)was significantly lower than that of low risk group(<3 points)(P=0.054).The AUC of the nomogram model integrating the above five factors achieved 0.752(AUC=0.752,95%CI:0.659~0.845),and the model prediction of patients survive rate was consistent in the actual survive rate.Conclusion:The overall survival rate of ASC was low.Surgical,chemotherapy,combined therapy,brain metastasis and inflammatory changes surrounding the tumor are independent risk factors of ASC lung cancer patients.The prediction model based on the multi-indicators can assist the clinical diagnosis and prognosis of ASC lung cancer patients.

关 键 词：腺鳞癌 肿瘤标志物 凝血功能指标 影像学征象 预后 

分 类 号：R734.2[医药卫生—肿瘤]