本文選題：肺癌 + 轉(zhuǎn)移��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]1.回顧性分析我院初診原發(fā)性肺癌患者的病例資料,研究肺癌患者的臨床特點(diǎn)、肺癌患者有無發(fā)生轉(zhuǎn)移與臨床相關(guān)指標(biāo)的差異。2.分析我院肺癌骨轉(zhuǎn)移、肺癌腦轉(zhuǎn)移及肺癌肝轉(zhuǎn)移患者的臨床特點(diǎn)及預(yù)后。[方法]應(yīng)用昆明醫(yī)科大學(xué)第三附屬醫(yī)院(云南省腫瘤醫(yī)院)病案系統(tǒng)檢索2014年1月1日至2014年12月31日首診我院確診為原發(fā)性肺癌患者的臨床資料,篩選符合入組標(biāo)準(zhǔn)的病例880例。記錄患者首診的臨床相關(guān)資料,并通過電話隨訪獲得生存資料。根據(jù)研究目的,選取部分?jǐn)?shù)據(jù)應(yīng)用SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,探究本組原發(fā)性肺癌患者的臨床特點(diǎn)及轉(zhuǎn)移患者的臨床特點(diǎn)。對(duì)是否發(fā)生轉(zhuǎn)移將患者進(jìn)行分組,采用統(tǒng)計(jì)學(xué)方法比較各項(xiàng)觀察指標(biāo)的差異,以P0. 05為差異具有統(tǒng)計(jì)學(xué)意義。分析肺癌骨轉(zhuǎn)移組、肺癌腦轉(zhuǎn)移組及肺癌肝轉(zhuǎn)移組患者的臨床特點(diǎn),采用Kaplan-Meier的log-rank檢驗(yàn)進(jìn)行患者生存率的單因素分析,采用Cox比例風(fēng)險(xiǎn)模型多因素分析方法進(jìn)行患者生存率的多因素分析。[結(jié)果]納入符合條件的原發(fā)性肺癌病例880例,男女比例2. 5:1。診斷中位年齡為58歲,高發(fā)年齡在40-70歲間。NSCLC 711例,占80. 8%。病理類型為腺癌474例(53.9%),鱗癌226例(25.7%)、小細(xì)胞肺癌132例(15.0%),其他病理類型48例(5.4%)。臨床分期:Ⅲ期、Ⅳ期最多,共693例,占全部病例的78. 7%,其中Ⅳ期390例(44. 3%)。Ⅳ期肺癌患者中,骨轉(zhuǎn)移169例(43. 33%);腦轉(zhuǎn)移88例(22. 56%),雙肺轉(zhuǎn)移86例(22.05%);胸膜轉(zhuǎn)移73例(18.72%);肝轉(zhuǎn)移60例(15.38%);其他部位轉(zhuǎn)移較少。轉(zhuǎn)移的患者的營(yíng)養(yǎng)狀況較未出現(xiàn)轉(zhuǎn)移的患者差。出現(xiàn)轉(zhuǎn)移的患者纖維蛋白原、血液粘滯度、腫瘤標(biāo)志物均明顯升高。肺癌骨轉(zhuǎn)移患者169例,中位年齡58歲,男女比例1.5:1。病理學(xué)類型腺癌117例最多,其次是鱗癌22例,其他病理類型少見。78.1%的患者為多發(fā)骨轉(zhuǎn)移。首診時(shí)即有55.6%的患者存在骨相關(guān)事件。此組病例Kaplan-Meier分析Log-Rank法結(jié)果顯示病理類型、血鈣濃度、合并其他部位轉(zhuǎn)移、肺部病灶手術(shù)治療、化療、靶向治療、鍶89治療及雙磷酸鹽治療與原發(fā)性肺癌骨轉(zhuǎn)移患者的預(yù)后有相關(guān)性。Cox比例風(fēng)險(xiǎn)模型多因素分析顯示化療、靶向治療和合并其他部位轉(zhuǎn)移是肺癌骨轉(zhuǎn)移的獨(dú)立預(yù)后影響因子。肺癌腦轉(zhuǎn)移患者88例,中位年齡58歲,男女比例約為2:1。病理類型腺癌48例最多,小細(xì)胞肺癌20例,其他病理類型較少。72. 7%的患者為多發(fā)腦轉(zhuǎn)移,31. 8%患者出現(xiàn)顱高壓。此組病例Kaplan-Meier分析Log-Rank法結(jié)果顯示年齡、病理類型、白蛋白水平、化療、靶向治療、全腦放療、治療模式和肺癌腦轉(zhuǎn)移預(yù)后有相關(guān)性。Cox比例風(fēng)險(xiǎn)模型多因素分析顯示化療和靶向治療是肺癌腦轉(zhuǎn)移的獨(dú)立預(yù)后影響因子。肺癌肝轉(zhuǎn)移患者60例,中位年齡59. 5歲,男女比例為3:1。肺癌肝轉(zhuǎn)移患者中小細(xì)胞癌23例最多,其次是腺癌21例,其他病理類型較少。以多發(fā)肝轉(zhuǎn)移為主,占73. 3%, 21. 7%的患者合并有肝炎病史。Kaplan-Meier分析Log-Rank法結(jié)果顯示病理類型、靶向治療和抗腫瘤治療與肺癌肝轉(zhuǎn)移的生存相關(guān)。Cox比例風(fēng)險(xiǎn)模型多因素分析顯示病理類型和抗腫瘤治療是肺癌肝轉(zhuǎn)移的獨(dú)立預(yù)后影響因子。[結(jié)論]原發(fā)性肺癌患者有年輕化趨勢(shì),且近半數(shù)患者初診即出現(xiàn)轉(zhuǎn)移。轉(zhuǎn)移患者較無轉(zhuǎn)移患者營(yíng)養(yǎng)狀態(tài)及肝腎功能差,高凝狀態(tài)明顯、血清腫瘤標(biāo)志物明顯升高。肺癌骨轉(zhuǎn)移患者最多,腺癌及多發(fā)骨轉(zhuǎn)移常見,肺癌骨轉(zhuǎn)移患者合并其他部位轉(zhuǎn)移、化療、靶向治療是獨(dú)立預(yù)后因素。肺癌腦轉(zhuǎn)移患者較多,肺癌腦轉(zhuǎn)移患者化療、靶向治療是獨(dú)立預(yù)后因素。肺癌肝轉(zhuǎn)移患者較少,肺癌肝轉(zhuǎn)移患者的病理類型、有無抗腫瘤治療是獨(dú)立預(yù)后因素。
[Abstract]:[Objective]1. retrospective analysis of the case data of primary lung cancer patients in our hospital, the clinical characteristics of lung cancer patients, the difference of metastasis and clinical related indexes of lung cancer patients with.2. analysis of the clinical characteristics and prognosis of lung cancer bone metastases, lung cancer and lung cancer patients in our hospital. [methods] apply the Kunming Medical University (method). Three affiliated hospital (Yunnan Cancer Hospital) medical record system retrieved the clinical data of the primary lung cancer patients first diagnosed in our hospital from January 1, 2014 to December 31, 2014, selected 880 cases in accordance with the standard of entry group, recorded the clinical data of the first diagnosis of the patients, and obtained the survival data by telephone interview. SPSS 20 software was used for statistical analysis to explore the clinical characteristics of the patients with primary lung cancer and the clinical characteristics of the patients with metastasis. The differences of the observation indexes were compared with the statistical methods, and the difference of the P0. 05 was statistically significant. The lung cancer bone metastasis group and lung were analyzed. The clinical characteristics of the patients with cancer brain metastasis and liver metastasis of lung cancer were analyzed by single factor analysis of the patient's survival rate by Kaplan-Meier log-rank test. Multifactor analysis of the patient's survival rate was carried out by the multifactor analysis of Cox proportional risk model. [results] were included in 880 cases of eligible primary lung cancer cases, the proportion of men and women was 2. 5:1. The median age of diagnosis was 58 years and 711 cases of.NSCLC with high incidence of age 40-70 years, 474 cases of adenocarcinoma (53.9%), 226 cases of squamous carcinoma (25.7%), 132 cases of small cell lung cancer (15%), and 48 cases (5.4%) with other pathological types. Clinical stages: Stage III, stage IV, most of all cases, among them, stage IV lung cancer. There were 169 cases (43.33%) of bone metastases, 88 cases of brain metastases (22.56%), 86 cases of double lung metastasis (22.05%), 73 cases of pleural metastasis (18.72%), 60 cases of liver metastasis (15.38%) and less metastasis. The nutritional status of the metastatic patients was less than that of those who had not been transferred. The fibrinogen, blood viscosity, and tumor markers were obvious in the metastatic patients. There were 169 cases of lung cancer with bone metastases in 169 cases, with a median age of 58 years, 117 cases of male and female pathological type adenocarcinoma, 22 cases of squamous cell carcinoma, and multiple bone metastases in other.78.1% patients with other pathological types. 55.6% of the patients had bone related events at the first diagnosis. The Kaplan-Meier analysis of Log-Rank showed the pathological class. Type, blood calcium concentration, combined other site metastasis, pulmonary focus operation, chemotherapy, targeting therapy, strontium 89 therapy, and bisphosphonate therapy and prognosis of patients with primary lung cancer with bone metastases, there is a correlation.Cox proportional risk model multifactor analysis shows chemotherapy, targeted therapy, and other site metastasis are independent prognosis of bone metastasis in lung cancer Ringing factor. 88 cases of lung cancer with brain metastases, with a median age of 58 years, 48 cases of 2:1. pathological type adenocarcinoma, 20 cases of small cell lung cancer, 20 cases of small cell lung cancer, multiple brain metastases in other patients with less.72. 7%, and 31.8% patients with cranial high pressure. This group of cases Kaplan-Meier analysis Log-Rank results showed age, pathological type, albumin Levels, chemotherapy, targeted therapy, whole brain radiotherapy, treatment model, and prognosis of lung cancer were correlated with.Cox proportional risk model multivariate analysis showed that chemotherapy and targeted therapy were independent prognostic factors of lung cancer. 60 cases of lung cancer patients with lung cancer were 59.5 years of age, and the proportion of men and women was small and medium cells of liver metastases in 3:1. lung cancer. There were 23 cases of cancer, followed by adenocarcinoma in 21 cases, other pathological types were less. Multiple liver metastases, accounting for 73.3%, 21.7% of the patients were combined with.Kaplan-Meier analysis of the history of hepatitis. The Log-Rank method showed the pathological type. The multiple factor analysis of the.Cox proportional risk model for the survival of the target therapy and the cancer treatment and the liver metastasis of lung cancer showed that the multiple factor analysis of the risk model of the survival of the liver metastasis of lung cancer showed the disease Type and antitumor therapy are the independent prognostic factors of liver metastasis in lung cancer. [Conclusion] the patients with primary lung cancer have a tendency to be young, and nearly half of the patients have metastasized first diagnosis. Adenocarcinoma and multiple bone metastasis are common, the patients with lung cancer with metastasis of other parts, chemotherapy and targeted therapy are independent prognostic factors. There are more patients with lung cancer with brain metastases, chemotherapy for lung cancer, and targeted therapy is an independent prognostic factor. The pathological type of lung cancer patients with lung cancer is less, and there is no antitumor treatment for patients with lung cancer. It is an independent prognostic factor.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2

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