本文關(guān)鍵詞： 肺癌 中國 臨床特點　出處：《浙江大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景:肺癌已成為我國發(fā)病率最高的癌癥,死亡率也居各類腫瘤之首。2015年,我國新增肺癌患者733300例,死亡610200例。迄今我國對肺癌患者的臨床信息登記并不完善細致,這也導致我國肺癌患者的相關(guān)臨床信息,包括:組織病理學構(gòu)成、各分期患者比例、抽煙情況、基因突變情況等并不清晰。另一方面,我國肺癌患者的死亡率也高于世界平均水平,這與早期發(fā)現(xiàn)早期診斷不足有關(guān),約2/3患者確診時已是進展期。過去5年來,隨著醫(yī)療保險在我國,尤其東部沿海地區(qū)的普及,越來越多的患者得以早期診斷和治療。早診患者的增多是否帶來不同亞群構(gòu)成的變化尚不清楚。目的:本研究以我國東部一大型綜合性醫(yī)院收治的肺癌患者為對象,旨在分析近5年來(2011-2015)新診斷肺癌患者的相關(guān)臨床特征及變化趨勢,從而對我國肺癌患者的臨床特征和變化趨勢有一個較為詳細的了解。方法:回顧性研究2011年1月-2015年12月期間在浙江大學醫(yī)學院附屬第二醫(yī)院首診為肺癌的病例,所有患者均經(jīng)肺部組織病理活檢或細胞學或外科手術(shù)切除組織病理檢測確診�；颊吲R床信息、影像資料通過醫(yī)院信息管理系統(tǒng)(HIS)獲得。肺癌診斷分期原則以第7版TNM腫瘤分期標準為依據(jù)。數(shù)據(jù)整理收集后通過spass 20.0進行統(tǒng)計分析。結(jié)果:2011-2015年間,本院新診斷肺癌共5779例,其中男性3719例,平均年齡62.7歲;女性2060例,平均年齡59.7歲。各種不同病理類型的構(gòu)成比如下:腺癌60.0%,鱗癌25.6%,小細胞肺癌8.5%,大細胞肺癌0.6%,腺鱗癌1%,其他非小細胞肺癌1.6%,不能明確分類的病理類型2.8%。女性中腺癌比例(86.9%)明顯高于男性(45.1%)。過去5年中,無相關(guān)呼吸系統(tǒng)癥狀而因體檢發(fā)現(xiàn)確診的患者比例逐年升高,從21.6%升至27.5%;與此同時腺癌患者比例呈逐漸上升趨勢(從54.1%升至62.5%),鱗癌比例卻逐漸下降(從31.8%降至23.4%),小細胞肺癌所占比例變化不大。因呼吸道及肺部癥狀就診而確診的肺癌患者中,晚期肺癌(TNM分期ⅢB-Ⅳ期)的比例達50.7%,遠高于因體檢發(fā)現(xiàn)而確診的患者(21.4%),而早期(0-Ⅰ期)比例則顯著低于后者(20.3%vs56.6%)。確診的肺癌患者中,男性有吸煙史的比例占80.2%,而女性有吸煙史的僅占2.7%。509例患者,包括440腺癌,61例鱗癌和8例腺鱗癌患者接受了 EGFR基因突變檢測,結(jié)果顯示:女性腺癌患者中EGFR基因突變率達66%,Exon21 L858R和Exon19 DEL是最常見突變類型,占91%;男性腺癌患者EGFR基因突變率37%,Exon21L858R和Exon19DEL占88%。61例鱗癌患者中,僅一例患者Exon20 S768I突變。8例腺鱗癌患者中6例患者EGFR突變陽性。結(jié)論:本研究從多方面對肺癌患者的臨床特點進行分析闡述,包括:年齡分布、性別、吸煙史、病理分型、組織學構(gòu)成、腫瘤分期、基因突變檢測等,得出結(jié)論如下:(1)在肺癌各病理亞型中,腺癌為最常見類型,女性中腺癌比例更是高達86.9%,這可能與我國女性患者的吸煙率低有關(guān)。(2)過去5年中,因體檢發(fā)現(xiàn)得以確診的患者比例逐年升高,這部分患者中腺癌比例達84%,而因呼吸系統(tǒng)相關(guān)癥狀就診確診的肺癌患者中腺癌比例僅55%。(3)過去5年中,腺癌患者比例呈逐漸上升趨勢,而鱗癌比例逐漸下降,這與體檢發(fā)現(xiàn)得診的患者比例逐年增高有關(guān)。(4)因呼吸系統(tǒng)相關(guān)癥狀就診而確診的肺癌患者中,晚期肺癌(IIIB-IV期)的比例顯著高于因體檢發(fā)現(xiàn)而確診的患者,而早期(0-1期)比例顯著低于后者,提示通過常規(guī)CT檢查可使更多患者在早期得以診斷。(5)腺癌患者中女性EGFR基因突變陽性率約是男性的兩倍,Exon21 L858R和Exon19 DEL是最常見突變類型。
[Abstract]:Background: lung cancer has become the highest incidence of cancer, mortality is the first among all the tumors in.2015, China's 733300 new cases of lung cancer, 610200 cases of death. So far our registration clinical information on lung cancer patients is not perfect, it also leads to clinical information related to lung cancer patients in China include: histopathological staging, the proportion of patients, smoking, gene mutation is not clear. On the other hand, China's lung cancer mortality rate is also higher than the world average level, and the lack of early detection and early diagnosis, about 2/3 patients are diagnosed at advanced stage. Over the past 5 years, with the medical insurance in me in China, especially in the eastern coastal areas of popularity, more and more patients to early diagnosis and treatment of early diagnosis in patients with increased. Whether bring different subsets changes is unclear. Objective: in this study, a large Eastern China From the type of general hospital lung cancer patients as the research object, aims to analyze the past 5 years (2011-2015) clinical features and trends of newly diagnosed lung cancer patients, and clinical characteristics and trends of patients with lung cancer in China have a more detailed understanding. Methods: a retrospective study in January 2011 -2015 year in December in affiliated the second hospital of Zhejiang University medical college first diagnosed as lung cancer patients, all patients were confirmed by lung biopsy or cytology or histopathology examination confirmed surgical resection. Patients with clinical information, imaging data through the hospital information management system (HIS). The diagnosis of lung cancer staging principle in the seventh edition of TNM staging is based on the standard of spass 20. Through statistical analysis of the data collected. Results: after 2011-2015 years, the new diagnosis of lung cancer were 5779 cases, including 3719 cases of male, mean age 62.7 years; 2060 were female , the average age of 59.7 years. Of different pathological types were as follows: 60% adenocarcinoma, 25.6% squamous cell carcinoma, small cell lung cancer 8.5%, large cell lung cancer 0.6%, 1% adenosquamous carcinoma, other 1.6% non-small cell lung cancer, adenocarcinoma ratio can not clear classification of pathological types of 2.8%. women (86.9%) was significantly higher than that of male (45.1%) for the past 5 years, no related respiratory symptoms and physical findings were due to the proportion of patients increased year by year, from 21.6% to 27.5%; at the same time the proportion of patients with adenocarcinoma was increased (from 54.1% to 62.5%), the proportion of squamous cell carcinoma is decreased (from 31.8% to 23.4%), small cell lung cancer accounted for little change. Due to respiratory and pulmonary symptoms and diagnosis of lung cancer in patients with advanced non-small cell lung cancer (TNM stage III B- IV) ratio reached 50.7%, far higher than for physical examination and diagnosis of patients (21.4%), and early (0- stage) ratio is significantly lower than the latter (20. 3%vs56.6%). Diagnosed lung cancer patients, male smokers accounted for 80.2%, while women with a history of smoking accounted for only 2.7%.509 patients, including 440 adenocarcinoma, 61 cases of squamous cell carcinoma and 8 cases of adenosquamous carcinoma patients received detection of mutations in the EGFR gene results showed that the mutation rate of 66% female patients with adenocarcinoma of the EGFR gene in Exon21, L858R and Exon19 DEL are the most common type of mutations, accounted for 91% of male patients with adenocarcinoma; EGFR gene mutation rate was 37%, Exon21L858R and Exon19DEL accounted for 88%.61 cases of squamous cell carcinoma patients, only one patient of Exon20 S768I mutation in.8 cases of adenosquamous carcinoma in 6 cases of patients with EGFR mutation positive. Conclusion: This study analyzes and the clinical features of lung cancer patients from many aspects including age distribution, gender, smoking history, pathological type, histological structure, tumor staging, gene mutation detection, the conclusions are as follows: (1) in various pathological subtypes of lung cancer, adenocarcinoma is the most common type, Female adenocarcinoma proportion is as high as 86.9%, which may be related to Chinese women with low smoking rates. (2) in the past 5 years, due to the increasing proportion of patients diagnosed physical examination revealed adenocarcinoma patients in the proportion reached 84%, but due to related symptoms of respiratory system were diagnosed with lung cancer in the proportion of adenocarcinoma is only 55%. (3) in the past 5 years, the proportion of patients with adenocarcinoma showed a gradual upward trend, while the proportion of squamous cell carcinoma is gradually decreased, and the examination found that the proportion of patients diagnosed increased year by year. (4) associated with respiratory symptoms were diagnosed in patients with lung cancer, lung cancer (IIIB-IV) the ratio was significantly higher than for physical examination and diagnosed early, and (0-1) was significantly lower than that of the latter, prompted by the conventional CT examination can make more patients can be diagnosed at an early stage. (5) female patients with adenocarcinoma in EGFR gene mutation rate is about two times of the male, Exon2 1 L858R and Exon19 DEL are the most common mutation types.

【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R734.2

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相關(guān)期刊論文 前1條

1 ZOU Xiao Nong;LIN Dong Mei;WAN Xia;CHAO Ann;FENG Qin Fu;DAI Zhen;YANG Gong Huan;LV Ning;;Histological Subtypes of Lung Cancer in Chinese Males from 2000 to 2012[J];Biomedical and Environmental Sciences;2014年01期

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本文編號：1498060