【摘要】：研究背景與目的在我國常見的各種類型的惡性腫瘤中,肺癌的發(fā)病率和死亡率都居于首位。肺癌通�？梢苑譃閮纱箢�,即非小細(xì)胞肺癌(NSCLC)和小細(xì)胞肺癌(SCLC)。對于早、中期非小細(xì)胞肺癌患者而言,進行手術(shù)治療對他們預(yù)后的改善有著十分重大的意義,但與此同時,手術(shù)治療會不可避免的帶來一些問題。進行手術(shù)治療之后,患者往往會出現(xiàn)各種類型的并發(fā)癥,如術(shù)后發(fā)熱、疼痛、炎癥等等。非甾體類抗炎藥(NSAIDs)是一類在臨床上應(yīng)用非常廣泛的藥物,在外科手術(shù)治療中,經(jīng)常被用于緩解術(shù)后的發(fā)熱、疼痛、炎癥等。此外,已有很多研究表明非甾體類抗炎藥具有抗腫瘤活性,可以在一定程度上降低部分腫瘤的發(fā)生率和致死率。行非小細(xì)胞肺癌切除術(shù)后應(yīng)用非甾體類抗炎藥對術(shù)后發(fā)熱患者的預(yù)后到底會有怎樣的影響,目前尚沒有相關(guān)的研究或者報道。因此,就這一問題,我們開展了一項相關(guān)的回顧性研究。本研究旨在分析和探討術(shù)后發(fā)熱患者應(yīng)用非甾體類抗炎藥對其無進展生存期(PFS)和總生存期(OS)的影響。研究方法我們對2011年7月到2013年6月期間在山東省立醫(yī)院胸外科做過非小細(xì)胞肺癌切除術(shù)的患者的臨床資料(包括性別、年齡、吸煙史、臨床病理資料、術(shù)后隨訪資料、術(shù)后應(yīng)用非甾體類抗炎藥的種類及劑量等)進行了收集與整理,并對這些臨床資料進行了回顧性分析。通過Kaplan-Meier生存曲線法和Cox回歸分析法,我們對患者的臨床資料進行了生存分析,并應(yīng)用亞組分析的方法評估術(shù)后應(yīng)用非甾體類抗炎藥對各亞組患者人群的作用。此項回顧性研究的主要觀察終點為總生存期,次要觀察終點為無進展生存期。研究結(jié)果此項回顧性研究一共納入了 347例接受了手術(shù)治療的非小細(xì)胞肺癌患者。評估術(shù)后應(yīng)用非甾體類抗炎藥與各臨床病理信息是否相關(guān)時,卡方檢驗結(jié)果顯示:術(shù)后是否應(yīng)用非甾體類抗炎藥只與病理組織類型(P=0.013)相關(guān),而與其他各臨床因素沒有統(tǒng)計學(xué)意義上的關(guān)聯(lián)。評估各項臨床信息與患者生存預(yù)后之間的關(guān)系時,多因素Cox回歸分析結(jié)果顯示:術(shù)后應(yīng)用非甾體類抗炎藥的非小細(xì)胞肺癌患者的總生存期(HR:0.528,95%CI:0.278-0.884,P=0.006)和無進展生存期(HR:0.557,95%CI:0.317-0.841,P=0.002)與未應(yīng)用非甾體類抗炎藥的非小細(xì)胞肺癌患者有顯著性差異。亞組分析結(jié)果表明:在高齡、男性、低吸煙指數(shù)、低分化和非腺癌患者的亞組中,術(shù)后應(yīng)用非甾體類抗炎藥的非小細(xì)胞肺癌患者的總生存期與未應(yīng)用非甾體類抗炎藥的非小細(xì)胞肺癌患者有顯著性差異。結(jié)論在行非小細(xì)胞肺癌切除術(shù)的術(shù)后發(fā)熱患者中,尤其是在高齡、男性、低吸煙指數(shù)、低分化和非腺癌這些亞組中,術(shù)后應(yīng)用非甾體類抗炎藥的患者比沒有應(yīng)用非甾體類抗炎藥的患者預(yù)后更好。應(yīng)用非甾體類抗炎藥可以改善術(shù)后發(fā)熱患者的預(yù)后,給患者帶來更多的臨床獲益。
[Abstract]:Background and objective Lung cancer is the leading cause of morbidity and mortality among the common types of malignant tumors in China. Lung cancer can be divided into two main categories, namely, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). For early and medium-term non-small cell lung cancer patients, surgical treatment has great significance to improve their prognosis, but at the same time, surgical treatment will inevitably bring some problems. After surgical treatment, patients often have a variety of complications, such as postoperative fever, pain, inflammation and so on. Non-steroidal anti-inflammatory drug (NSAIDs) is a kind of widely used drugs in clinic. It is often used to relieve postoperative fever, pain, inflammation and so on in surgical treatment. In addition, many studies have shown that non-steroidal anti-inflammatory drugs have anti-tumor activity, which can reduce the incidence and mortality of some tumors to a certain extent. There is no relevant research or report on the effect of NSAIDs on the prognosis of postoperative fever patients after resection of NSCLC. Therefore, we have carried out a related retrospective study on this issue. The purpose of this study was to investigate the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on progressive survival (PFS) and total survival (OS) in patients with fever after operation. Methods from July 2011 to June 2013, we studied the clinical data (including sex, age, smoking history, clinicopathological data, postoperative follow-up data) of patients with non-small cell lung cancer (NSCLC) who had been performed in thoracic surgery of Shandong Provincial Hospital from July 2011 to June 2013. The kinds and doses of nonsteroidal anti-inflammatory drugs were collected and sorted, and the clinical data were analyzed retrospectively. By means of Kaplan-Meier survival curve and Cox regression analysis, we analyzed the clinical data of the patients, and evaluated the effect of NSAIDs on the patients after operation by subgroup analysis. The primary observation endpoint of this retrospective study was the total survival period, and the secondary observation endpoint was progressive survival. Results the retrospective study included 347 patients with non-small cell lung cancer who underwent surgical treatment. To assess the correlation between postoperative application of NSAIDs and clinicopathological information, chi-square test showed that the use of NSAIDs after surgery was only associated with pathological tissue type (P0. 013). There was no statistically significant correlation with other clinical factors. When evaluating the relationship between clinical information and survival and prognosis of patients, multivariate Cox regression analysis showed that the total survival time (HR:0.528,95%CI:0.278-0.884,) of patients with NSAIDs after operation was higher than that of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with non-small cell lung cancer (NSCLC). P0. 006) and progression free survival (HR:0.557,95%CI:0.317-0.841,P=0.002) were significantly different from those of non steroidal anti-inflammatory drugs (NSAIDs) in patients with non-small cell lung cancer (NSCLC). Subgroup analysis showed that in elderly, male, low smoking index, low differentiation and non-adenocarcinoma subgroups, There was a significant difference between the total survival time of patients with NSCLC treated with non-steroidal anti-inflammatory drugs (NSAIDs) and non-steroidal anti-inflammatory drugs (NSAIDs). Conclusion in patients with postoperative fever after non-small cell lung cancer resection, especially in the elderly, male, low smoking index, low differentiation and non-adenocarcinoma subgroups, Postoperative NSAIDs had a better prognosis than those without NSAIDs. The application of non-steroidal anti-inflammatory drugs can improve the prognosis of postoperative patients with fever and bring more clinical benefits.
【學(xué)位授予單位】：山東大學(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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