摘要:
目的：本课题主要探讨肺腺癌患者是否接受化疗及化疗周期数、是否放疗、是否接受过靶向治疗以及具体应用哪种靶向药物对其预后的影响，旨在找出影响肺腺癌预后的临床因素，为肺腺癌患者开展个体化治疗、延长生存期提供理论依据。方法：以2010年1月至2012年12月间首次就诊于秦皇岛市第一医院经病理学检查确诊为肺腺癌且无其他严重基础疾病及未接受过任何抗肿瘤治疗的168例患者为研究对象(临床资料信息来源：恶性肿瘤患者会定期返院做放化疗或全面复查评估病情，患者的一般情况、肿瘤情况、治疗情况及血分析检查都有完整的住院志记录，同时结合自己电话随访结果)。采用SPSS17.0进行统计分析，采用Kaplan-Meier生存分析、Log-rank检验分析比较各临床特征对预后的影响，采用Cox回归模型进行多因素分析，找出肺腺癌患者预后的独立因素，以P < 0.05为差异有统计学意义。结果：单因素分析可见化疗与否及化疗周期数、是否应用过靶向治疗均可影响肺腺癌患者的预后(P值均 < 0.05)，而患者确诊年龄、性别、吸烟与否及吸烟数量、恶性肿瘤家族史、是否接受过放疗等因素对预后无明显影响(P值均 > 0.05)。统计分析结果显示口服TKI类药物者、使用抗肿瘤血管生成类药物者及两种药物均使用者，三者中位生存期间无明显差异(P = 0.230)。单纯靶向治疗者既应用靶向治疗又接受化疗者、既应用靶向治疗又接受放疗者及既应用靶向治疗又接受放化疗者，各组间中位生存期有差异(P = 0.020)。Cox比例风险模型结果显示化疗与否及化疗周期数、是否应用过靶向治疗是影响肺腺癌预后的独立因素(P值均 < 0.05)。结论：化疗及应用靶向治疗是影响肺腺癌患者预后的独立因素，靶向治疗可改善肺腺癌患者的预后，既应用靶向治疗又行放化疗可延长肺腺癌患者的生存期。
Abstract:
Objectives: The subject of this study is to investigate whether the lung adenocarcinoma patients accept chemotherapy and the cycles of chemotherapy, whether they accept radiotherapy, whether they have received targeted therapy and what specific targeted drugs they used and the effect on prognosis, aiming to find out the influential clinical factors in the prognosis of lung adenocarcinoma in order to provide a theoretical basis to carry out individualized treatment and prolong the survival time of the patients. Methods: 168 Patients who first received treatment from January 2010 to December 2012 in the first hospital of Qinhuangdao and diagnosed through pathological science examination with lung adenocarcinoma were enrolled. These patients do not have other serious underlying diseases and have never received any anti-tumor therapy. Statistical data are analyzed by SPSS17.0. Kaplan-Meier survival analysis and Log-rank test analysis are applied to compare the influences of clinical features on the prognosis. Cox regression model is used for multivariate analysis to identify independent factors of prognosis in patients with lung adenocarcinoma. The difference value of P < 0.05 is considered statistically significant. Result: It is found through single factor analysis that whether they have received surgical treatment or chemotherapy, the number of chemotherapy cycles, and whether targeted treatment has been applied to them have effect on the prognosis of lung adenocarcinoma patients (P value < 0.05). In contrast, little effects can be found in factors such as patient’s age when diagnosed, gender, whether they smoke or not, the number of cigarettes they smoke, family history of malignant tumor, experience of radiotherapy (P value > 0.05). Statistical analysis showed that there were no significant differences in the median survival time between who took TKI drugs, who used anti-angiogenesis drugs and who used both of the drugs (P = 0.230). There were significant differences in the median survival time between who received targeted treatment alone, who received targeted treatment and chemotherapy, who received targeted treatment and radiotherapy and who received targeted treatment, chemotherapy and radiotherapy (P = 0.020). Cox proportional hazards model showed that the independent factors affecting the prognosis of lung adenocarcinoma included: whether patients received chemotherapy or not, chemotherapy cycles, whether patients received targeted therapy (P < 0.05). Conclusion: Chemotherapy and targeted therapy are independent prognostic factors in patients with lung adenocarcinoma. Targeted therapy helps to improve the prognosis in patients with lung adenocarcinoma. The combination of targeted therapy, chemotherapy and radiotherapy can prolong the survival time for patients with lung adenocarcinoma.