晚期肺鳞癌患者共病及生存情况分析

王振雷; 高雪峰; 樊剑; 杨昉; 韩一平

doi:10.16766/j.cnki.issn.1674-4152.004248

晚期肺鳞癌患者共病及生存情况分析

doi: 10.16766/j.cnki.issn.1674-4152.004248

1.
海军军医大学第一附属医院全科医学科, 上海 200433
2.
东部战区总医院神经内科, 江苏南京 210002

基金项目:

上海市自然科学基金项目 19411970600

详细信息

通讯作者:
韩一平，E-mail：yphan2006@163.com

中图分类号: R734.2 R730.7
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出版历程
- 收稿日期: 2024-11-05
- 网络出版日期: 2026-01-07

Analysis of comorbidities and survival of patients with advanced lung squamous cell carcinoma

1.
Department of General Practice, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China

摘要

摘要: 目的分析晚期肺鳞癌患者的临床特征和共病患病情况，探讨晚期肺癌患者预后的影响因素。方法回顾性分析2017年1月—2021年12月海军军医大学第一附属医院呼吸内科收治的晚期肺鳞癌患者的临床资料，随访截止时间为2023年8月31日。统计分析患者的性别、年龄、症状、吸烟情况、癌症分期、治疗情况以及生存期等相关指标，采用简化合并症评分(SCS)量化评估共病情况。采用Kaplan-Meier法绘制患者总生存期(OS)生存曲线，以单因素和多因素Cox回归分析共病对晚期肺鳞癌OS的预测能力，并分析影响晚期肺鳞癌预后的因素。结果共纳入247例患者，平均年龄为65.57岁，男性217例，女性30例，193例患者有吸烟史，死亡197例。患者中位SCS评分为8分(0~15分)，不同SCS评分组患者生存期差异有统计学意义(P＜0.05)。单因素分析显示，性别、吸烟史、纤维蛋白原、PS评分、免疫治疗、SCS评分、慢性肺部疾病均为OS的影响因素(P＜0.05)。多因素Cox回归分析显示，吸烟史、纤维蛋白原、PS评分、免疫治疗、SCS评分、慢性肺部疾病是晚期肺鳞癌患者OS的独立影响因素。结论简化合并症评分、慢性肺部疾病是晚期肺鳞癌患者OS的独立影响因素。
- 晚期肺鳞癌 /
- 共病 /
- 慢性肺部疾病 /
- 简化合并症评分 /
- 总生存期
Abstract: Objective To analyze the clinical characteristics and comorbidities of patients with advanced lung squamous cell carcinoma and to explore the prognostic factors of patients with advanced lung cancer. Methods Clinical data of patients with advanced lung squamous cell carcinoma admitted to the Department of Respiratory Medicine from January 2017 to December 2021 were retrospectively analyzed, with follow-up completed in August 2023. Variables including gender, age, symptoms, smoking status, cancer stage, treatment status, and survival time of patients were statistically analyzed. The simplified comorbidity score (SCS) was used to quantitatively evaluate comorbidities. Kaplan-meier method was used to draw the overall survival (OS) survival curve of patients, and univariate and multivariate Cox regression analyses were used to analyze the predictive ability of OS and to identify prognostic factors in patients with advanced lung squamous cell carcinoma. Results A total of 247 patients were included, with an average age of 65.57 years, 217 cases were male, 30 cases were female, 193 cases had a smoking history, and 197 died during follow-up. In this study, the median score of SCS was 8 points (range 0-15), and significant differences in survival were observed among groups with different SCS assessments (P < 0.05). Univariate analysis showed that gender, smoking history, fibrinogen, PS score, immunotherapy, SCS score, and chronic lung disease were influencing factors of OS (P < 0.05). Multivariate Cox regression analysis showed that smoking history, fibrinogen, PS score, immunotherapy, SCS score, and chronic lung disease were independent factors affecting OS in patients with advanced lung squamous cell carcinoma. Conclusion The simplified comorbidity score and the presence of chronic lung disease are independent risk factors for OS in patients with advanced lung squamous cell carcinoma.
- Advanced lung squamous cell carcinoma /
- Comorbidity /
- Chronic lung disease /
- Simplified comorbidity score /
- Overall survival

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图 1 不同SCS评分组晚期肺鳞癌患者生存情况

Figure 1. Survival of patients with advanced lung squamous cell carcinoma in different SCS score groups

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图 2 不同SCS评分组晚期肺鳞癌患者总生存期曲线

注：剔除者为随访结束时的生存者。

Figure 2. Overall survival curve of patients with advanced lung squamous cell carcinoma in different SCS groups

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图 3 不同SCS评分组Ⅲ期和Ⅳ期肺鳞癌患者总生存期曲线

注：剔除者为随访结束时的生存者。

Figure 3. Overall survival curves of patients with stage Ⅲ and stage Ⅳ lung squamous cell carcinoma in different SCS score groups

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表 1 SCS评分量表内容

Table 1. Simplified Comorbidities Score (SCS) scale

评分	共病
1分	嗜酒(男性≥80 g/d, 女性≥40 g/d)；心脑血管疾病(心力衰竭、冠状动脉疾病、严重的心脏瓣膜病、脑血管病、高血压病、外周血管疾病)；肿瘤(不包括皮肤基底癌及宫颈原位癌)；呼吸系统疾病(结核病史、胸腔积液或肺炎史、哮喘、肺栓塞、慢性呼吸衰竭、慢性阻塞性肺疾病)
4分	肾功能不全(采用Cockcroft公式计算肌酐清除率≤60 mL/min)
5分	糖尿病
7分	吸烟(一生中至少吸烟≥100支)

下载: 导出CSV

表 2 晚期肺鳞癌患者OS的影响因素分析

Table 2. Analysis of factors influencing OS in patients with advanced lung squamous cell carcinoma

变量	单因素分析				多因素分析
变量	HR值	95% CI	Z值	P值	HR值	95% CI	P值
男性	2.362	1.464~3.811	3.524	＜0.001	1.019	0.530~1.961	0.954
诊断时年龄(岁)
51~60	1.103	0.567~2.147	0.289	0.773
61~70	1.282	0.681~2.415	0.770	0.441
≥71	1.421	0.751~2.691	1.079	0.280
BMI
18~24	0.835	0.460~1.514	-0.594	0.552
＞24	0.829	0.446~1.542	-0.592	0.554
有吸烟史	3.005	2.047~4.413	5.615	＜0.001	2.047	1.055~3.974	0.034
白蛋白≥40 g/L	0.961	0.708~1.305	-0.253	0.801
纤维蛋白原＞4 g/L	1.472	1.081~2.006	2.451	0.014	1.690	1.212~2.355	0.002
肿瘤分期Ⅳ期	1.163	0.873~1.550	1.031	0.303
PS评分≥2分	1.804	1.146~2.840	2.547	0.011	1.706	1.055~2.759	0.030
治疗方案
化疗	0.647	0.382~1.096	-1.619	0.105
放疗	0.783	0.589~1.042	-1.678	0.093
靶向治疗	0.951	0.689~1.312	-0.306	0.759
免疫治疗	0.726	0.547~0.964	-2.211	0.027	0.673	0.496~0.912	0.011
共病
心肌梗死	1.026	0.505~2.085	0.070	0.944
心力衰竭	1.980	0.276~14.201	0.680	0.497
周围血管疾病	1.962	0.625~6.155	1.155	0.248
脑血管疾病	0.548	0.077~3.924	-0.599	0.549
慢性肺部疾病	2.781	1.995~3.877	6.036	＜0.001	1.758	1.028~3.005	0.039
结缔组织病	＜0.001	＜0.001~null	-0.009	0.993
中重度肝病	1.043	0.333~3.273	0.073	0.942
酗酒	1.917	0.939~3.914	1.788	0.074
心脑血管疾病	0.893	0.658~1.211	-0.730	0.465
其他肿瘤	1.558	0.386~6.286	0.623	0.533
糖尿病	1.315	0.891~1.942	1.379	0.168
SCS评分(分)
8~9	2.922	2.092~4.082	6.288	＜0.001	1.579	0.808~3.086	0.182
≥10	4.186	2.641~6.635	6.091	＜0.001	2.425	1.147~5.128	0.020
注：由于在患有结缔组织病的患者组中未观察到死亡事件(完全分离)，无法计算有效的HR值及95% CI；各变量赋值方法如下，女性=0，男性=1；诊断时年龄＜50岁=0，51~60岁=1，61~70岁=2，≥71岁=3；BMI＜18=0，18~24=1，＞24=2；无吸烟史=0，有=1；白蛋白＜40 g/L=0，≥40 g/L=1；纤维蛋白原≤40 g/L=0，＞40 g/L=1；肿瘤分期为Ⅲ期=0，Ⅳ期=1；PS评分＜2分=0，≥2分=1；治疗方案，未接受该治疗=0，接受该治疗=1；共病，无该共病=0，有该共病=1；SCS评分≤7分=0，8~9分=1，≥10分=2。性别以女性为参照；诊断时年龄以≤50岁为参照；BMI以＜18为参照；吸烟史以无为参照；白蛋白以＜40 g/L为参照；纤维蛋白原以≤4 g/L为参照；肿瘤分期以Ⅲ期为参照；PS评分以＜2分为参照；治疗方案以未接受该治疗为参照；共病以无该共病为参照；SCS评分以0~7分为参照。

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