發(fā)布時間：2018-07-29 10:56

【摘要】：目的:肺癌是目前全世界公認的最常見的惡性腫瘤,由于其預后差,病死率高,生存期短,故危害嚴重。肺腺癌作為肺癌的主要病理類型,近年來其發(fā)病率呈上升趨勢,因肺腺癌典型表現(xiàn)為小的外周病灶,不易被發(fā)現(xiàn),且極易出現(xiàn)區(qū)域淋巴結和遠處轉移,故5年生存率低。但隨著近年來研究的進展,治療多樣化及靶向藥物的問世,肺腺癌患者的生存期較前明顯延長,且個體間存在較大差異。因此,分析影響肺腺癌預后的因素顯得尤為重要。我們都知道,影響腫瘤預后的因素有很多,通過對肺腺癌患者分析可發(fā)現(xiàn),患者在自身因素、腫瘤情況及所接受治療等方面均存在較大差異,主要表現(xiàn)在確診年齡、性別、吸煙與否及吸煙數(shù)量、腫瘤分期及腫瘤細胞分化程度、是否存在臟器轉移及具體轉移部位、是否存在多臟器轉移、是否行手術治療、是否接受化療及化療周期數(shù)、是否放療、是否接受過靶向治療以及具體應用的哪種靶向藥物等方面。本課題主要探討上述各因素對肺腺癌預后的影響,旨在找出影響肺腺癌預后的臨床因素,為肺腺癌患者開展個體化治療、延長生存期提供理論依據(jù)。方法:以2010年1月至2012年12月間首次就診于秦皇島市第一醫(yī)院經(jīng)病理學檢查確診為肺腺癌且無其他嚴重基礎疾病及未接受過任何抗腫瘤治療的患者為研究對象。共收集168例肺腺癌患者,對患者年齡、性別、吸煙情況、惡性腫瘤家族史、腫瘤分期及分化程度、臟器轉移情況及具體治療方案等信息進行詳細記錄,電話隨訪所有患者至2015年12月31日,記錄患者總生存期作為預后指標。統(tǒng)計數(shù)據(jù)均采用SPSS17.0統(tǒng)計軟件進行統(tǒng)計分析,采用Kaplan-Meier生存分析、Log-rank檢驗分析比較各臨床特征對預后的影響,采用Cox回歸模型進行多因素分析,找出肺腺癌患者預后的獨立因素,以P0.05為差異有統(tǒng)計學意義。結果:對168例肺腺癌患者進行隨訪,截止到2015年12月31日,失訪9例,隨訪率94.6%,存活11例,因肺癌死亡148例。分析168例肺腺癌患者預后情況,其總生存期為0.5個月到68.2個月,中位生存期為14.2個月,1年生存率為60.2%,2年生存率為34.1%,3年生存率為20.2%。綜合分析168例肺腺癌患者臨床特征對其預后的影響,單因素分析可見腫瘤分期、腫瘤細胞分化程度、確診時是否存在腦、骨、肝等臟器的轉移及是否同時存在多器官轉移、是否手術治療、化療與否及化療周期數(shù)、是否應用過靶向治療均可影響肺腺癌患者的預后(p值均0.05),而患者確診年齡、性別、吸煙與否及吸煙數(shù)量、惡性腫瘤家族史、是否接受過放療等因素對預后無明顯影響(p值均0.05)。靶向治療改善了肺腺癌患者的預后,在本研究中,共計69例肺腺癌患者接受了靶向治療,中位生存期為21.6個月,所使用的靶向治療藥物主要有兩類,小分子酪氨酸激酶抑制劑(tyrosinekinaseinhibitors,tki)類藥物和抗腫瘤血管生成(單抗)類藥物。其中口服tki類藥物者48例,中位生存期為19.6個月,使用抗腫瘤血管生成類藥物者14例,中位生存期為32.2個月,兩種藥物均有使用者7例,中位生存期為21.6個月,但統(tǒng)計學分析顯示三者中位生存期間無明顯差異(p=0.230)。在治療方案選擇上,單純靶向治療者6例,中位生存期為13.5個月,既應用靶向治療又接受化療者23例,中位生存期為24.2個月,既應用靶向治療又接受放療者9例,中位生存期為12.7個月,既應用靶向治療又接受放化療者31例,中位生存期為30.6個月,統(tǒng)計學分析顯示各組間中位生存期有差異(p=0.020),也就是說既應用靶向治療又接受放化療者中位生存期最長。將上述單因素分析得出的對肺腺癌預后有影響的9項因素引入cox比例風險模型,結果顯示腫瘤分期、腫瘤細胞分化程度、確診時伴有腦轉移、確診時伴有骨轉移、確診時伴有肝轉移、是否接受過手術治療、化療與否及化療周期數(shù)、是否應用過靶向治療共計8項臨床特征是影響肺腺癌預后的獨立因素(p值均0.05)。結論:1、肺腺癌患者預后受腫瘤情況、治療方式等多因素影響。2、腫瘤分期、腫瘤細胞分化程度、腦轉移、骨轉移、肝轉移、手術、化療及應用靶向治療均是影響肺腺癌患者預后的獨立因素。3、靶向治療可改善肺腺癌患者的預后,既應用靶向治療又行放化療可延長肺腺癌患者的生存期。
[Abstract]:Objective: lung cancer is the most common malignant tumor in the world. Because of its poor prognosis, high mortality and short survival time, lung adenocarcinoma is the main pathological type of lung cancer. In recent years, the incidence of lung adenocarcinoma is on the rise. The typical manifestation of lung adenocarcinoma is small peripheral focus, it is not easy to be found, and regional lymph node is easy to appear. With the distant metastasis, the 5 year survival rate is low. But with the progress of research in recent years, the survival period of the patients with lung adenocarcinoma is longer than before, and there is a great difference between individuals. Therefore, the factors that affect the prognosis of lung adenocarcinoma are particularly important. We all know that the factors affecting the prognosis of the tumor are very important. More, by analyzing the patients with lung adenocarcinoma, it is found that the patients have great differences in their own factors, tumor conditions and treatment, such as the age, sex, smoking and smoking, the number of smoking and smoking, the stage of tumor and the degree of differentiation of the tumor cells, whether they exist in the organs and the specific metastatic sites, and whether there are multiple organs. Whether surgery is performed, whether or not the number of chemotherapy and chemotherapy cycles, whether radiotherapy, whether the target therapy is accepted, and what kind of targeted drugs are used, this subject is mainly to explore the effects of these factors on the prognosis of lung adenocarcinoma, in order to find out the clinical factors affecting the prognosis of lung adenocarcinoma and to develop individuals for lung adenocarcinoma. Methods: a total of 168 patients with lung adenocarcinoma were collected from January 2010 to December 2012, and 168 patients with lung adenocarcinoma were collected for the first time in Qinhuangdao First Hospital. The information of smoking, family history of malignant tumor, tumor stage and differentiation, organ metastasis and specific treatment were recorded in detail. All patients were followed up to December 31, 2015 by telephone, and the total survival time was recorded as a prognostic indicator. Statistical data were statistically analyzed by SPSS17.0 software, and Kaplan-Meie R survival analysis, Log-rank test analysis and comparison of the impact of the clinical features on the prognosis, using the Cox regression model for multiple factors analysis to find out the independent factors of the prognosis of the lung adenocarcinoma, the difference of P0.05 was statistically significant. Results: 168 cases of lung adenocarcinoma were followed up to December 31, 2015, 9 cases were lost, the follow-up rate was 94.6%, survival. 11 cases of lung cancer died in 148 cases. The prognosis of 168 cases of lung adenocarcinoma was analyzed. The total survival period was 0.5 months to 68.2 months, the median survival period was 14.2 months, the 1 year survival rate was 60.2%, the 2 year survival rate was 34.1%, and the 3 year survival rate was 20.2%. comprehensive analysis of the clinical characteristics of the patients with lung adenocarcinoma. The single factor analysis showed the tumor. Stage, the degree of differentiation of tumor cells, whether there is the metastasis of brain, bone, liver and other organs at the time of diagnosis, whether there is multiple organ transfer at the same time, whether surgical treatment, chemotherapy or not and the number of chemotherapy cycles, and whether the use of targeted therapy can affect the prognosis of patients with lung adenocarcinoma (P value is 0.05), and the age, sex, smoking and smoking and smoking number of patients are confirmed. Dose, family history of malignant tumor and whether or not radiotherapy and other factors have no significant influence on prognosis (P value is 0.05). Targeted therapy improves the prognosis of lung adenocarcinoma. In this study, 69 cases of lung adenocarcinoma received targeted therapy with a median survival period of 21.6 months, and there were two types of targeted therapy drugs, small molecule tyrosine. Tyrosinekinaseinhibitors (tyrosinekinaseinhibitors, TKI) drugs and antitumor angiogenesis (Dan Kang) drugs. Among them, 48 cases were taken orally, the median survival period was 19.6 months, 14 cases were used antitumor angiogenesis drugs, the median survival period was 32.2 months, two drugs were used in 7 cases, and the median survival period was 21.6 months. The analysis showed that there was no significant difference in the median survival of the three patients (p=0.230). In the choice of treatment, 6 cases were only targeted therapy, the median survival period was 13.5 months, 23 cases were both targeted and received chemotherapy, the median survival period was 24.2 months, both targeted and radiotherapy 9 cases, the median survival period was 12.7 months, both 31 patients with radiotherapy and chemotherapy were treated with targeted therapy and the median survival period was 30.6 months. Statistical analysis showed that the median survival time was different between each group (p=0.020), that is to say, the median survival period was the longest in both targeted and chemoradiotherapy. 9 factors influencing the prognosis of lung adenocarcinoma by the above single factor analysis were introduced into the Cox ratio. The results showed that the tumor stage, the degree of tumor cell differentiation, the diagnosis accompanied by brain metastases, the diagnosis accompanied by the bone metastasis, the diagnosis accompanied by the liver metastasis, whether the liver metastases were diagnosed, whether the surgery was accepted, the chemotherapy or not and the number of chemotherapy cycles, and whether the 8 clinical features of the target therapy were independent factors (P value was 0). 5) 5) conclusion: 1, the prognosis of lung adenocarcinoma patients is affected by tumor condition, treatment mode and other factors affecting.2, tumor staging, tumor cell differentiation, brain metastasis, bone metastasis, liver metastasis, operation, chemotherapy and targeted therapy are independent factors affecting the prognosis of lung adenocarcinoma patients.3, targeted therapy can improve the prognosis of lung adenocarcinoma, both target treatment and treatment can be used. Radiotherapy and chemotherapy can prolong the survival of patients with lung adenocarcinoma.
【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R734.2

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