本文選題：非小細胞肺癌 + 預(yù)后��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:回顧性分析我院Ⅰ期非小細胞肺癌(Non-small cell lung cancer,NSCLC)患者的臨床、病理特征,并研究與其預(yù)后的相關(guān)因素。方法:收集2006年1月至2013年12月在廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院胸瘤外科行手術(shù)治療的233例Ⅰ期NSCLC患者的住院病歷資料。記錄患者首發(fā)癥狀、性別、年齡、吸煙史、術(shù)前血小板計數(shù)(Platelet,PLT)、術(shù)前血紅蛋白(hemoglobin,HGB)濃度、術(shù)前癌胚抗原(carcinoma embryonic antigen,CEA)濃度、手術(shù)方式,包括開胸手術(shù)及電視輔助胸腔鏡手術(shù)(video-assisted thoracoscopic surgery,VATS)、淋巴結(jié)清掃情況、腫瘤最大徑、腫瘤部位、病理類型、分化程度、臟層胸膜侵犯(Visceral pleura invasion,VPI)、脈管癌栓(vessel invasion,VI),包括血管癌栓(blood vessel invasion,BVI)和淋巴管癌栓(lymphatic vessel invasion,LVI)、輔助化療及生存情況,研究上述因素對患者生存率的影響。通過電話、門診等形式進行隨訪及查詢我院隨訪辦公室資料以獲取生存數(shù)據(jù)。采用SPSS17.0軟件進行統(tǒng)計分析,以構(gòu)成比描述臨床、病理特征。運用壽命表法計算全組患者1、3、5年累積生存率,單因素生存分析予KaplanMeier法(Log-rank檢驗),多因素分析予COX回歸模型。采用X 2檢驗評估VI、VPI與其他臨床、病理特征之間的關(guān)系。以P0.05為有統(tǒng)計學(xué)意義。結(jié)果:1.臨床、病理特征男性發(fā)病率(57.9%)比女性(42.1%)稍高,男女之比為1.4:1。隨著年齡增高,發(fā)病率均呈先升后降的變化趨勢,51-70歲發(fā)病率達高峰(70.9%)。首發(fā)癥狀以咳嗽(53.6%)為主,其次為咳痰。主動吸煙91例(39.1%),無吸煙142(60.9%),男性吸煙比例明顯高于女性(65.2%vs3.1%)。腫瘤位于右肺較左側(cè)稍多(58.4%vs41.6%),上葉居多(59.6%)。ia期占71.2%,ib期占28.8%。腫瘤最大徑3cm(54.9%)稍多于腫瘤最大徑≥3cm,≤5cm(45.1%)。病理類型以腺癌為主(76.0%),其次為鱗癌(15.5%)。高中分化比例(67.8%)高于低分化(32.2%)。bvi(4.7%)、lvi(4.3%)、vpi(9.0%),所占比例均較小。hgb110g/l(7.7%)、plt300×109/l(18.0%)及cea5.0μg/l(32.2%)患者所占比例均較小。開胸手術(shù)146例(62.7%),vats87例(37.3%),清掃縱隔淋巴結(jié)組數(shù)≥3組178例(76.4%),清掃淋巴結(jié)總個數(shù)≥6枚206例(88.4%),行輔助化療共49例(21.0%)。2.生存預(yù)后分析全組患者術(shù)后1年、3年、5年累積生存率分別為96.5%、88.8%、77.0%。單因素生存分析結(jié)果顯示性別、吸煙、hgb、plt、cea、手術(shù)方式、腫瘤位置及vpi對預(yù)后的影響均無統(tǒng)計學(xué)意義(p0.05)。年齡、腫瘤最大徑、tnm分期、t分期、病理類型、分化程度、vi、清掃縱隔淋巴結(jié)組數(shù)、清掃淋巴結(jié)總個數(shù)與預(yù)后有關(guān)(p0.05)。多因素分析結(jié)果顯示腫瘤最大徑≥3cm,≤5cm、分化程度低、vi、清掃縱隔淋巴結(jié)的組數(shù)3組及清掃淋巴結(jié)總個數(shù)6枚均是影響預(yù)后的獨立高危因素。3.ib期nsclc未能從術(shù)后輔助化療中獲益。4.vi多見于低分化腫瘤。結(jié)論:1.年齡、腫瘤最大徑、tnm分期、t分期、病理類型、分化程度、vi、清掃縱隔淋巴結(jié)組數(shù)、清掃淋巴結(jié)總個數(shù)與i期nsclc預(yù)后密切相關(guān),其中腫瘤最大徑≥3cm,≤5cm、分化程度低、VI、清掃縱隔淋巴結(jié)組數(shù)3組及清掃淋巴結(jié)總個數(shù)6枚均是影響預(yù)后的獨立高危因素,建議對高�；颊咝行g(shù)后輔助化療從而延長遠期生存。2.VATS與開胸手術(shù)對I期NSCLC患者生存的影響無明顯差異。3.Ib期NSCLC不能從術(shù)后輔助化療中獲益,可能使伴高危因素患者獲益。4.VI多見于低分化腫瘤。
[Abstract]:Objective: To review the clinical and pathological features of Non-small cell lung cancer (NSCLC) patients in phase I of our hospital and to study the related factors of its prognosis. Methods: to collect the hospitalization records of 233 stage I NSCLC patients who were operated in the external department of the Thoracic Tumor Hospital of Guangxi Medical University from January 2006 to December 2013. Data. Records of patients' initial symptoms, sex, age, smoking history, preoperative platelet count (Platelet, PLT), preoperative hemoglobin (hemoglobin, HGB) concentration, preoperative carcinoembryonic antigen (carcinoma embryonic antigen, CEA) concentration, surgical methods, including thoracotomy and video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery, VATS), and drenching. The maximum diameter, tumor site, tumor location, pathological type, degree of differentiation, Visceral pleura invasion, VPI, vessel invasion (VI), vascular tumor thrombus (blood vessel invasion, BVI), and lymphatic tumor thrombus (lymphatic), adjuvant chemotherapy and survival were studied, and the factors mentioned above were studied. The effect of the patient's survival rate was followed up by telephone and outpatient service and inquiring into the data of the follow-up office in our hospital to obtain the survival data. The SPSS17.0 software was used to analyze the clinical and pathological features. The cumulative survival rate of the whole group of patients was calculated by using the life table method, and the single factor survival analysis was given to KaplanMeier. The method (Log-rank test), multivariate analysis was given to the COX regression model. The relationship between VI, VPI and other clinical and pathological features was evaluated by X 2 test. The results were statistically significant with P0.05. Results: 1. clinical and pathological male incidence (57.9%) was slightly higher than that of women (42.1%), and the ratio of male and female to 1.4:1. increased with age, and the incidence of the disease increased first and then descended. The incidence of the 51-70 year old was up to the peak (70.9%). The first symptoms were cough (53.6%), followed by expectoration, 91 (39.1%), 142 (60.9%) without smoking. The male smoking ratio was significantly higher than that of the female (65.2%vs3.1%). The tumor located in the right lung was slightly more than that in the left (58.4%vs41.6%), the upper leaves were more (59.6%).Ia, 71.2%, and the IB period accounted for the 28.8%. tumor most. The largest diameter 3cm (54.9%) was slightly more than the maximum diameter of the tumor more than 3cm and less than 5cm (45.1%). The pathological type was mainly adenocarcinoma (76%), and the second was squamous cell carcinoma (15.5%). The proportion of high school differentiation (67.8%) was higher than that of low differentiation (32.2%).Bvi (4.7%), LVI (4.3%), VPI (9%), and the proportion of.Hgb110g/l (7.7%), plt300 * 109/l (18%) and cea5.0 mu g/l (32.2%) patients were all in proportion. Smaller. 146 cases (62.7%), vats87 (37.3%), 178 cases (76.4%) of lymph node dissection of mediastinum, 178 cases (76.4%), total number of lymph nodes in 206 (88.4%), 49 cases (21%) survival after adjuvant chemotherapy (49 cases (21%) survival analysis, 1 years after operation, 3 years, 3 years, 77.0%. single factor survival analysis results showed significant results. The effects of sex, smoking, HGB, PLT, CEA, operation mode, tumor location and VPI on prognosis were not statistically significant (P0.05). Age, maximum diameter of tumor, TNM stage, T stage, pathological type, differentiation degree, VI, the number of lymph nodes in mediastinum, total number of lymph node dissection and prognosis (P0.05). The results of multifactor analysis showed that the maximum diameter of tumor was more than 3C. M, < 5cm, low degree of differentiation, VI, the number of 3 groups of lymph node dissection of mediastinum and 6 of the total number of lymph nodes were all the independent high risk factors affecting the prognosis. NSCLC failed to benefit.4.vi from postoperative adjuvant chemotherapy. Conclusion: the 1. age, the maximum diameter of the tumor, the TNM stage, the T staging, the pathological type, the degree of differentiation, VI, and sweep. The total number of septum groups was closely related to the prognosis of I phase NSCLC. The maximum diameter of the tumor was more than 3cm, less than 5cm, and the degree of differentiation was low. VI, the number of 3 groups of lymph node dissection and the total number of 6 lymph nodes were all the independent risk factors affecting the prognosis. It is suggested that adjuvant chemotherapy for high-risk patients should be performed to prolong the long-term survival of.2.. There is no significant difference in the impact of VATS and thoracotomy on the survival of patients with stage I NSCLC..3.Ib NSCLC can not benefit from postoperative adjuvant chemotherapy, and may benefit patients with high risk factors to gain more.4.VI in low differentiated tumors.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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