回顧性分析術(shù)后輔助化療對具有高危因素的IB期非小細(xì)胞肺癌預(yù)后的影響
發(fā)布時間：2018-08-09 19:12
【摘要】：目的:采用回顧性病例分析的方法研究術(shù)后輔助化療對具有高危因素的IB期非小細(xì)胞肺癌(non-small cell lung cancer,NSCLC)5年無病生存率(5-year disease free survival rate,5y-DFS rate)的影響、臨床病理特征與5y-DFS rate的相關(guān)性及術(shù)后輔助化療對具有獨立預(yù)后因素的患者5y-DFS rate的影響,為IB期NSCLC的治療策略提供依據(jù)。材料與方法:通過聯(lián)眾數(shù)字化病案瀏覽系統(tǒng)搜集2008年1月1日至2012年1月1日期間大連醫(yī)科大學(xué)附屬第一醫(yī)院收治的行肺切除術(shù)及淋巴結(jié)廓清術(shù)患者。根據(jù)病例選取及排除標(biāo)準(zhǔn),符合條件且病例資料完整的IB期NSCLC患者共63例。統(tǒng)計患者臨床病理特征:性別、年齡、組織學(xué)類型、分化程度、腫瘤最大徑、臟層胸膜受累情況、脈管是否受侵、是否行楔形切除、是否行術(shù)后輔助化療、化療方案及化療周期數(shù)。采用查閱電子病歷資料及電話隨訪的方法對所有患者按計劃進行隨訪�；颊哂腥魏螐�(fù)發(fā)癥狀、體征,可隨時進行影像學(xué)檢查。隨訪截止日期為2017年1月1日。采用SPSS 19.0對數(shù)據(jù)進行統(tǒng)計學(xué)分析。行輔助化療與未行輔助化療患者之間臨床病理特征的差異性采用卡方檢驗。預(yù)后單因素分析應(yīng)用Kaplan-Meier法,并繪制出生存曲線,用Log-rank檢測統(tǒng)計學(xué)預(yù)后因素差異性。將單因素分析有意義及結(jié)合相關(guān)研究可能有意義的因素納入COX比例風(fēng)險模型中進行多因素分析,得出IB期NSCLC 5年無病生存率的獨立影響因素。在探究術(shù)后輔助化療對具有獨立預(yù)后因素患者5y-DFS rate的影響時,采用分層log-rank檢驗。以p0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1、截止本研究隨訪終點2017年1月1日,63例IB期NSCLC患者中有20例出現(xiàn)復(fù)發(fā)轉(zhuǎn)移,5y-DFS rate為66.3%。2、單因素分析結(jié)果顯示:行術(shù)后輔助化療的IB期NSCLC患者5年無病生存率為81.1%,未行術(shù)后輔助化療的患者5年無病生存率為47.4%,與5y-DFS rate有相關(guān)性(p=0.012);低分化患者5年無病生存率為48.3%,中高分化患者5年無病生存率為78.4%,與5y-DFS rate有相關(guān)性(p=0.043);脈管受侵的患者5年無病生存率為56.4%,脈管未受侵的患者5年無病生存率為74.1%,與5y-DFS rate有相關(guān)性(p=0.039);楔形切除患者5年無病生存率為44.0%,非楔形切除的患者5年無病生存率為78.1%,與5y-DFS rate有相關(guān)性(p=0.016);胸膜受累的患者5年無病生存率為58.8%,胸膜未受累的患者5年無病生存率為86.7%,與5y-DFS rate無相關(guān)性,但p值為0.074,接近0.05;性別、年齡、組織學(xué)類型及腫瘤最大徑與5y-DFS rate無相關(guān)性。3、多因素分析結(jié)果顯示:腫瘤分化程度(p=0.037)、臟層胸膜受累(p=0.044)及脈管受侵(p=0.020)為IB期NSCLC患者5y-DFS rate的獨立預(yù)后因素;術(shù)后輔助化療為具有高危因素的IB期NSCLC患者5y-DFS rate的獨立預(yù)后因素(p=0.015)。4、分層分析結(jié)果顯示:臟層胸膜受累的IB期NSCLC患者,行術(shù)后輔助化療其5y-DFS rate為77.6%,未行術(shù)后輔助化療者5y-DFS rate為36.6%,p值為0.008,差異有統(tǒng)計學(xué)意義;脈管受侵的患者,行術(shù)后輔助化療其5y-DFS rate為75.0%,未行術(shù)后輔助化療者5y-DFS rate為33.3%,p值為0.030,差異有統(tǒng)計學(xué)意義;而對于低分化的患者,行術(shù)后輔助化療與未行術(shù)后輔助化療者5y-DFS rate差異無統(tǒng)計學(xué)意義。結(jié)論:1、對具有臟層胸膜受累、脈管受侵的IB期NSCLC患者行術(shù)后輔助化療可能延緩疾病復(fù)發(fā)時間;2、術(shù)后輔助化療可能為具有高危因素的IB期NSCLC 5年無病生存率的獨立預(yù)后因素。
[Abstract]:Objective: To study the effect of postoperative adjuvant chemotherapy on the 5 year disease-free survival rate of non-small cell lung cancer (NSCLC) in IB stage non small cell lung cancer (5-year disease free survival rate, 5y-DFS) with a retrospective case analysis. The effect of 5y-DFS rate in patients with independent prognostic factors provides a basis for the treatment strategy of IB phase NSCLC. Materials and methods: collect pulmonary resection and lymph node dissection in the First Affiliated Hospital of Dalian Medical University from January 1, 2008 to January 1, 2012. A total of 63 patients with IB phase NSCLC were excluded from the criteria, and the clinicopathological features of the patients: sex, age, histological type, degree of differentiation, the maximum diameter of the tumor, the involvement of the pleura, whether the pulse tube was invaded, or whether the cuneiform resection was performed, the postoperative adjuvant chemotherapy, the chemotherapy regimen and the number of chemotherapy cycles. All patients were followed up by the methods of electronic medical records and telephone follow-up. The patients had any recurrent symptoms and signs and could be examined at any time. The deadline of follow-up was January 1, 2017. The data were statistically analyzed with SPSS 19. The clinicopathological features between adjuvant chemotherapy and non adjuvant chemotherapy were performed. The difference was based on Chi square test. The prognosis mono factor analysis was used Kaplan-Meier method, the birth memory curve was plotted and the difference of prognostic factors was detected by Log-rank. The single factor analysis was meaningful and the related research could be integrated into the COX proportional risk model for multi factor analysis, and the 5 year disease of NSCLC in IB period was found to be no disease. The independent influence factors of survival rate. In exploring the effect of postoperative adjuvant chemotherapy on 5y-DFS rate with independent prognostic factors, the stratified log-rank test was used. The difference between P0.05 and P0.05 was statistically significant. Results: 1, in the end of the study, 20 cases of IB stage NSCLC patients had relapse and metastasis, and 5y-DFS rate was 66.3. %.2, single factor analysis showed that the 5 year disease free survival rate of IB NSCLC patients with postoperative adjuvant chemotherapy was 81.1%. The 5 year disease-free survival rate of patients without postoperative adjuvant chemotherapy was 47.4% and 5y-DFS rate was associated (p=0.012); the 5 year disease-free survival rate of the low differentiated patients was 48.3%, the 5 year disease-free survival rate of middle and high differentiation patients was 78.4%, and 5y-DFS rat. E was related (p=0.043); the 5 year disease free survival rate of the patients with vascular invasion was 56.4%, the 5 year disease-free survival rate of the patients with unaffected vasculature was 74.1%, and the 5y-DFS rate was correlated (p=0.039); the 5 year disease free survival rate of the cuneiform excision patients was 44%, the 5 year disease free survival rate of the non wedge excised patients was 78.1%, and the chest was associated with the rate (p=0.016); chest (p=0.016); chest (p=0.016); chest. The 5 year disease-free survival rate of the patients with membrane involvement was 58.8%, the 5 year disease-free survival rate of the pleural unaffected patients was 86.7%, and there was no correlation with 5y-DFS rate, but the p value was 0.074, close to 0.05; sex, age, histological type and the tumor maximum diameter were not associated with 5y-DFS rate, and the multifactor analysis showed that the degree of tumor differentiation (p=0.037) and the dirty pleura received. P=0.044 and vascular invasion (p=0.020) were independent prognostic factors of 5y-DFS rate in IB phase NSCLC patients; postoperative adjuvant chemotherapy was an independent prognostic factor (p=0.015) for IB phase NSCLC patients with high risk factors (p=0.015).4. The 5y-DFS rate was 36.6% and the value of P was 0.008, and the difference was statistically significant. The 5y-DFS rate of the patients with vascular invasion was 75% after the postoperative adjuvant chemotherapy, the 5y-DFS rate was 33.3% and the p value was 0.030 without postoperative adjuvant chemotherapy, and the postoperative adjuvant chemotherapy and failure were performed for the patients with low differentiation. There was no significant difference in 5y-DFS rate of post adjuvant chemotherapy. Conclusion: 1, postoperative adjuvant chemotherapy for IB phase NSCLC patients with intravascular pleura involvement may delay the time of disease recurrence; 2, postoperative adjuvant chemotherapy may be an independent prognostic factor of IB stage NSCLC 5 year disease free survival with high risk factors.
【學(xué)位授予單位】：大連醫(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
本文編號：2175039
[Abstract]:Objective: To study the effect of postoperative adjuvant chemotherapy on the 5 year disease-free survival rate of non-small cell lung cancer (NSCLC) in IB stage non small cell lung cancer (5-year disease free survival rate, 5y-DFS) with a retrospective case analysis. The effect of 5y-DFS rate in patients with independent prognostic factors provides a basis for the treatment strategy of IB phase NSCLC. Materials and methods: collect pulmonary resection and lymph node dissection in the First Affiliated Hospital of Dalian Medical University from January 1, 2008 to January 1, 2012. A total of 63 patients with IB phase NSCLC were excluded from the criteria, and the clinicopathological features of the patients: sex, age, histological type, degree of differentiation, the maximum diameter of the tumor, the involvement of the pleura, whether the pulse tube was invaded, or whether the cuneiform resection was performed, the postoperative adjuvant chemotherapy, the chemotherapy regimen and the number of chemotherapy cycles. All patients were followed up by the methods of electronic medical records and telephone follow-up. The patients had any recurrent symptoms and signs and could be examined at any time. The deadline of follow-up was January 1, 2017. The data were statistically analyzed with SPSS 19. The clinicopathological features between adjuvant chemotherapy and non adjuvant chemotherapy were performed. The difference was based on Chi square test. The prognosis mono factor analysis was used Kaplan-Meier method, the birth memory curve was plotted and the difference of prognostic factors was detected by Log-rank. The single factor analysis was meaningful and the related research could be integrated into the COX proportional risk model for multi factor analysis, and the 5 year disease of NSCLC in IB period was found to be no disease. The independent influence factors of survival rate. In exploring the effect of postoperative adjuvant chemotherapy on 5y-DFS rate with independent prognostic factors, the stratified log-rank test was used. The difference between P0.05 and P0.05 was statistically significant. Results: 1, in the end of the study, 20 cases of IB stage NSCLC patients had relapse and metastasis, and 5y-DFS rate was 66.3. %.2, single factor analysis showed that the 5 year disease free survival rate of IB NSCLC patients with postoperative adjuvant chemotherapy was 81.1%. The 5 year disease-free survival rate of patients without postoperative adjuvant chemotherapy was 47.4% and 5y-DFS rate was associated (p=0.012); the 5 year disease-free survival rate of the low differentiated patients was 48.3%, the 5 year disease-free survival rate of middle and high differentiation patients was 78.4%, and 5y-DFS rat. E was related (p=0.043); the 5 year disease free survival rate of the patients with vascular invasion was 56.4%, the 5 year disease-free survival rate of the patients with unaffected vasculature was 74.1%, and the 5y-DFS rate was correlated (p=0.039); the 5 year disease free survival rate of the cuneiform excision patients was 44%, the 5 year disease free survival rate of the non wedge excised patients was 78.1%, and the chest was associated with the rate (p=0.016); chest (p=0.016); chest (p=0.016); chest. The 5 year disease-free survival rate of the patients with membrane involvement was 58.8%, the 5 year disease-free survival rate of the pleural unaffected patients was 86.7%, and there was no correlation with 5y-DFS rate, but the p value was 0.074, close to 0.05; sex, age, histological type and the tumor maximum diameter were not associated with 5y-DFS rate, and the multifactor analysis showed that the degree of tumor differentiation (p=0.037) and the dirty pleura received. P=0.044 and vascular invasion (p=0.020) were independent prognostic factors of 5y-DFS rate in IB phase NSCLC patients; postoperative adjuvant chemotherapy was an independent prognostic factor (p=0.015) for IB phase NSCLC patients with high risk factors (p=0.015).4. The 5y-DFS rate was 36.6% and the value of P was 0.008, and the difference was statistically significant. The 5y-DFS rate of the patients with vascular invasion was 75% after the postoperative adjuvant chemotherapy, the 5y-DFS rate was 33.3% and the p value was 0.030 without postoperative adjuvant chemotherapy, and the postoperative adjuvant chemotherapy and failure were performed for the patients with low differentiation. There was no significant difference in 5y-DFS rate of post adjuvant chemotherapy. Conclusion: 1, postoperative adjuvant chemotherapy for IB phase NSCLC patients with intravascular pleura involvement may delay the time of disease recurrence; 2, postoperative adjuvant chemotherapy may be an independent prognostic factor of IB stage NSCLC 5 year disease free survival with high risk factors.
【學(xué)位授予單位】：大連醫(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
【參考文獻】
相關(guān)期刊論文 前3條
1 劉盛華;邵中夫;劉路浩;徐崗;饒旭光;陳永東;劉太省;;術(shù)后輔助化療與單純手術(shù)治療ⅠB期非小細(xì)胞肺癌的Meta分析[J];實用醫(yī)學(xué)雜志;2014年23期
2 毛鋒;潘雁;李子明;蔡明輝;申屠陽;;Ib期肺癌術(shù)后輔助化療高風(fēng)險因素分析[J];中國肺癌雜志;2014年05期
3 裴俊;韓寶惠;張杰;顧愛琴;;Ⅰ期非小細(xì)胞肺癌術(shù)后預(yù)后的多因素分析[J];中國肺癌雜志;2011年12期
，本文編號：2175039
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