【摘要】：目的:肺癌是目前全世界公認(rèn)的最常見(jiàn)的惡性腫瘤,由于其預(yù)后差,病死率高,生存期短,故危害嚴(yán)重。肺腺癌作為肺癌的主要病理類型,近年來(lái)其發(fā)病率呈上升趨勢(shì),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(jié)和遠(yuǎn)處轉(zhuǎn)移,故5年生存率低。但隨著近年來(lái)研究的進(jìn)展,治療多樣化及靶向藥物的問(wèn)世,肺腺癌患者的生存期較前明顯延長(zhǎng),且個(gè)體間存在較大差異。因此,分析影響肺腺癌預(yù)后的因素顯得尤為重要。我們都知道,影響腫瘤預(yù)后的因素有很多,通過(guò)對(duì)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(xì)胞分化程度、是否存在臟器轉(zhuǎn)移及具體轉(zhuǎn)移部位、是否存在多臟器轉(zhuǎn)移、是否行手術(shù)治療、是否接受化療及化療周期數(shù)、是否放療、是否接受過(guò)靶向治療以及具體應(yīng)用的哪種靶向藥物等方面。本課題主要探討上述各因素對(duì)肺腺癌預(yù)后的影響,旨在找出影響肺腺癌預(yù)后的臨床因素,為肺腺癌患者開(kāi)展個(gè)體化治療、延長(zhǎng)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(xué)檢查確診為肺腺癌且無(wú)其他嚴(yán)重基礎(chǔ)疾病及未接受過(guò)任何抗腫瘤治療的患者為研究對(duì)象。共收集168例肺腺癌患者,對(duì)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(zhuǎn)移情況及具體治療方案等信息進(jìn)行詳細(xì)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(yù)后指標(biāo)。統(tǒng)計(jì)數(shù)據(jù)均采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析,采用Kaplan-Meier生存分析、Log-rank檢驗(yàn)分析比較各臨床特征對(duì)預(yù)后的影響,采用Cox回歸模型進(jìn)行多因素分析,找出肺腺癌患者預(yù)后的獨(dú)立因素,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:對(duì)168例肺腺癌患者進(jìn)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(yù)后情況,其總生存期為0.5個(gè)月到68.2個(gè)月,中位生存期為14.2個(gè)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(duì)其預(yù)后的影響,單因素分析可見(jiàn)腫瘤分期、腫瘤細(xì)胞分化程度、確診時(shí)是否存在腦、骨、肝等臟器的轉(zhuǎn)移及是否同時(shí)存在多器官轉(zhuǎn)移、是否手術(shù)治療、化療與否及化療周期數(shù)、是否應(yīng)用過(guò)靶向治療均可影響肺腺癌患者的預(yù)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(guò)放療等因素對(duì)預(yù)后無(wú)明顯影響(p值均0.05)。靶向治療改善了肺腺癌患者的預(yù)后,在本研究中,共計(jì)69例肺腺癌患者接受了靶向治療,中位生存期為21.6個(gè)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(gè)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(gè)月,兩種藥物均有使用者7例,中位生存期為21.6個(gè)月,但統(tǒng)計(jì)學(xué)分析顯示三者中位生存期間無(wú)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(gè)月,既應(yīng)用靶向治療又接受化療者23例,中位生存期為24.2個(gè)月,既應(yīng)用靶向治療又接受放療者9例,中位生存期為12.7個(gè)月,既應(yīng)用靶向治療又接受放化療者31例,中位生存期為30.6個(gè)月,統(tǒng)計(jì)學(xué)分析顯示各組間中位生存期有差異(p=0.020),也就是說(shuō)既應(yīng)用靶向治療又接受放化療者中位生存期最長(zhǎng)。將上述單因素分析得出的對(duì)肺腺癌預(yù)后有影響的9項(xiàng)因素引入cox比例風(fēng)險(xiǎn)模型,結(jié)果顯示腫瘤分期、腫瘤細(xì)胞分化程度、確診時(shí)伴有腦轉(zhuǎn)移、確診時(shí)伴有骨轉(zhuǎn)移、確診時(shí)伴有肝轉(zhuǎn)移、是否接受過(guò)手術(shù)治療、化療與否及化療周期數(shù)、是否應(yīng)用過(guò)靶向治療共計(jì)8項(xiàng)臨床特征是影響肺腺癌預(yù)后的獨(dú)立因素(p值均0.05)。結(jié)論:1、肺腺癌患者預(yù)后受腫瘤情況、治療方式等多因素影響。2、腫瘤分期、腫瘤細(xì)胞分化程度、腦轉(zhuǎn)移、骨轉(zhuǎn)移、肝轉(zhuǎn)移、手術(shù)、化療及應(yīng)用靶向治療均是影響肺腺癌患者預(yù)后的獨(dú)立因素。3、靶向治療可改善肺腺癌患者的預(yù)后,既應(yīng)用靶向治療又行放化療可延長(zhǎng)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(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R734.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 常秀青 ,Tony Sheldon;低焦油含量香煙與肺腺癌發(fā)病率上升有關(guān)[J];英國(guó)醫(yī)學(xué)雜志(中文版);2002年01期

2 鄧小梅,何權(quán)瀛;細(xì)支氣管肺泡細(xì)胞癌與其他類型肺腺癌的對(duì)比分析[J];中國(guó)呼吸與危重監(jiān)護(hù)雜志;2005年03期

3 楊長(zhǎng)青;王蓮芳;;飛行人員右肺腺癌1例[J];海軍醫(yī)學(xué)雜志;2006年04期

4 陳小兵;閆明;羅素霞;李寧;鄒宏志;韓黎麗;;84例青年肺腺癌早期誤診原因分析[J];實(shí)用診斷與治療雜志;2007年09期

5 陳小兵;閆明;曾軍杰;羅素霞;;青年女性肺腺癌首發(fā)癥狀及早期誤診原因分析[J];中國(guó)現(xiàn)代醫(yī)生;2009年06期

6 周琪;段亮;姜格寧;丁嘉安;;青年男性肺腺癌臨床特征對(duì)預(yù)后的影響[J];中國(guó)癌癥雜志;2009年08期

7 張文麗;;以高熱為首發(fā)癥狀的肺腺癌病例并文獻(xiàn)復(fù)習(xí)[J];甘肅醫(yī)藥;2013年07期

8 郭哲;肺腺癌病人的預(yù)防性頭顱照射[J];國(guó)外醫(yī)學(xué)(腫瘤學(xué)分冊(cè));1988年06期

9 劉福升，李險(xiǎn)峰，，楊愛(ài)民，王彤;肺腺癌誤診肺結(jié)核16例分析[J];中國(guó)防癆雜志;1994年01期

10 余偉江;放療及合并化療治療Ⅲ期肺腺癌療效分析[J];腫瘤防治研究;1994年04期

相關(guān)會(huì)議論文 前10條

1 孫強(qiáng);顧春東;雷霆;王金;李錦繡;;浸潤(rùn)性周圍型小肺腺癌(≤2cm)不同病理亞型的比較[A];第13屆全國(guó)肺癌學(xué)術(shù)大會(huì)論文匯編[C];2013年

2 袁明遠(yuǎn);;周圍型肺腺癌病灶的放射學(xué)分類及其臨床價(jià)值[A];中華醫(yī)學(xué)會(huì)第16次全國(guó)放射學(xué)學(xué)術(shù)大會(huì)論文匯編[C];2009年

3 顧國(guó)浩;;生物芯片在肺腺癌診斷中的應(yīng)用進(jìn)展[A];中華醫(yī)學(xué)會(huì)第八次全國(guó)檢驗(yàn)醫(yī)學(xué)學(xué)術(shù)會(huì)議暨中華醫(yī)學(xué)會(huì)檢驗(yàn)分會(huì)成立30周年慶典大會(huì)資料匯編[C];2009年

4 林嘉穎;吳一龍;楊學(xué)寧;喬貴賓;王坤;陳剛;;不同預(yù)后的肺腺癌患者酪氨酸激酶信號(hào)傳導(dǎo)通路異常的初步探討[A];第三屆中國(guó)腫瘤學(xué)術(shù)大會(huì)教育論文集[C];2004年

5 湯秀英;吳立紅;張燁;;肺腺癌的超微觀察及異質(zhì)性探討[A];第八次全國(guó)電子顯微學(xué)會(huì)議論文摘要集（Ⅰ）[C];1994年

6 徐芝君;應(yīng)可凈;;胸部CT基本正常肺腺癌伴慢性DIC一例并文獻(xiàn)復(fù)習(xí)[A];浙江省醫(yī)學(xué)會(huì)呼吸系病分會(huì)成立三十周年慶典活動(dòng)暨2008年呼吸病學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2008年

7 邵艷;洪偉俊;寧允葉;胥武劍;李強(qiáng);;肺腺癌惡性轉(zhuǎn)化相關(guān)蛋白的初步篩查[A];中華醫(yī)學(xué)會(huì)呼吸病學(xué)年會(huì)——2011（第十二次全國(guó)呼吸病學(xué)學(xué)術(shù)會(huì)議）論文匯編[C];2011年

8 王恩華;;解讀及評(píng)價(jià)國(guó)際多學(xué)科肺腺癌分類[A];2012年浙江省病理學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

9 宋正波;朱慧能;郭振英;吳偉;孫文勇;張沂平;;肺腺癌新分類在預(yù)測(cè)Ⅰ期非小細(xì)胞肺腺癌預(yù)后中的價(jià)值[A];第13屆全國(guó)肺癌學(xué)術(shù)大會(huì)論文匯編[C];2013年

10 趙燕妮;曹菊;牟向東;闕呈立;;肺腺癌影像反復(fù)波動(dòng)病例報(bào)告一例并文獻(xiàn)復(fù)習(xí)[A];中華醫(yī)學(xué)會(huì)呼吸病學(xué)年會(huì)——2013第十四次全國(guó)呼吸病學(xué)學(xué)術(shù)會(huì)議論文匯編[C];2013年

相關(guān)重要報(bào)紙文章 前8條

1 丁香;日發(fā)現(xiàn)肺腺癌的預(yù)測(cè)因子[N];中國(guó)醫(yī)藥報(bào);2007年

2 仇逸邋孫國(guó)根;吸煙丈夫的妻子,患肺腺癌風(fēng)險(xiǎn)高[N];新華每日電訊;2007年

3 曾理;肺腺癌早診研究關(guān)注“起源”[N];健康報(bào);2008年

4 記者 李天舒　胡德榮;為何不吸煙者也患肺癌[N];健康報(bào);2010年

5 記者 胡德榮;非吸煙肺腺癌人群致癌基因突變譜建立[N];健康報(bào);2011年

6 高原;或與MiR-21分子有關(guān)[N];廣東科技報(bào);2009年

7 海飛魚(yú);探索肺癌突變基因[N];醫(yī)藥經(jīng)濟(jì)報(bào);2008年

8 健康時(shí)報(bào)記者 王志勝;一樣的腫瘤,不一樣治法[N];健康時(shí)報(bào);2009年

相關(guān)博士學(xué)位論文 前10條

1 孫正亮;肺腺癌的分子分型特征及其與病理分型的關(guān)聯(lián)研究[D];復(fù)旦大學(xué);2014年

2 朱聰惠;miR-183負(fù)調(diào)控下游靶基因PTPN4促進(jìn)肺腺癌始動(dòng)細(xì)胞侵襲遷移作用的研究[D];第三軍醫(yī)大學(xué);2016年

3 董瑜;中國(guó)人群肺腺癌驅(qū)動(dòng)基因表達(dá)與臨床特征及預(yù)后的相關(guān)性研究[D];上海交通大學(xué);2013年

4 楊欣;肺腺癌預(yù)后相關(guān)的臨床病理因素分析及分子病理研究[D];北京協(xié)和醫(yī)學(xué)院;2014年

5 鄭華;篩選肺腺癌相關(guān)血清自身抗體標(biāo)志物[D];北京市結(jié)核病胸部腫瘤研究所;2010年

6 張揚(yáng);肺腺癌致癌基因突變研究[D];復(fù)旦大學(xué);2013年

7 張麗;基于IASLC/ATS/ERS國(guó)際多學(xué)科新分類的肺腺癌影像學(xué)及相關(guān)研究[D];北京協(xié)和醫(yī)學(xué)院;2014年

8 楊繼要;肺腺癌腫瘤相關(guān)抗原的篩選鑒定及克隆表達(dá)[D];鄭州大學(xué);2006年

9 何萍;染色體15q25.1區(qū)域基因多態(tài)性與中國(guó)南方人群肺腺癌易感性的關(guān)聯(lián)研究[D];南方醫(yī)科大學(xué);2014年

10 李亞光;PI3K-Akt通路與肺腺癌術(shù)后患者預(yù)后的相關(guān)性研究[D];北京協(xié)和醫(yī)學(xué)院;2012年

相關(guān)碩士學(xué)位論文 前10條

1 蘇帆;rhPDCD5蛋白對(duì)肺腺癌A549細(xì)胞化療作用的研究[D];石河子大學(xué);2015年

2 卜靜;順鉑聯(lián)合雷帕霉素、3-MA對(duì)肺腺癌A549細(xì)胞及其裸鼠原位移植瘤的影響[D];河北醫(yī)科大學(xué);2015年

3 韓承剛;寶石CT灌注成像在肺腺癌生物治療療效評(píng)價(jià)中的應(yīng)用價(jià)值[D];山西醫(yī)科大學(xué);2015年

4 展峰峰;肺腺癌患者組織中EML4-ALK融合基因與TYMS mRNA表達(dá)的關(guān)系[D];山西醫(yī)科大學(xué);2015年

5 趙玉澤;Ago2蛋白在EGFR突變的肺腺癌患者中的表達(dá)及臨床意義[D];山西醫(yī)科大學(xué);2015年

6 孫天宇;轉(zhuǎn)錄輔助因子4過(guò)表達(dá)與肺腺癌淋巴轉(zhuǎn)移和預(yù)后的相關(guān)性[D];第三軍醫(yī)大學(xué);2015年

7 崔巍;肺腺癌患者外周血IL-17A~+T細(xì)胞和相關(guān)細(xì)胞因子檢測(cè)及意義[D];浙江大學(xué);2015年

8 趙鳳芝;bFGF單抗聯(lián)合Lobaplatin抑制肺腺癌細(xì)胞增殖、轉(zhuǎn)移和誘導(dǎo)凋亡的機(jī)制研究[D];暨南大學(xué);2015年

9 邊猛;溫通法聯(lián)合化療對(duì)EGFR-TKIs耐藥后的脾腎陽(yáng)虛型肺腺癌患者的臨床療效觀察[D];河南中醫(yī)學(xué)院;2015年

10 高正亞;Ⅰ期肺腺癌患者外周血和淋巴結(jié)中CK19及LUNX mRNA的表達(dá)與微轉(zhuǎn)移的相關(guān)性研究[D];蘇州大學(xué);2015年

本文編號(hào)：2152459