非小细胞肺癌根治术患者术后临床特征调查及预后影响因素分析

谢忠海; 李鸿伟; 臧金; 闵伟伟

doi:10.16766/j.cnki.issn.1674-4152.002720

非小细胞肺癌根治术患者术后临床特征调查及预后影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002720

湖州市中心医院胸心外科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2022RC261

详细信息

通讯作者:
李鸿伟, E-mail: zhonghai8585@163.com

中图分类号: R734.2 R730.7
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- 文章访问数: 218
- HTML全文浏览量: 43
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-15
- 网络出版日期: 2022-12-30

Investigation of clinical characteristics and prognostic factors in patients with non-small cell lung cancer after radical resection

Department of Cardiothoracic Surgery, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的分析行非小细胞肺癌根治术患者术后的临床特征及预后影响因素，为患者预后干预方案的制定提供理论依据。方法选择2013年1月—2016年12月在湖州市中心医院进行非小细胞肺癌根治术的非小细胞肺癌患者514例作为研究对象。统计患者术后的临床特征，并采用多因素分析探究影响非小细胞肺癌根治术患者预后的因素。结果 514例非小细胞肺癌根治术患者临床特征如下：病变部位处于右肺292例(56.81%)、左肺222例(43.19%)；组织学类型为腺癌284例(55.25%)、鳞癌206例(40.08%)；305例(59.34%)患者术后出现远处器官转移；肿瘤分化程度为低分化286例(55.64%)、中/高分化228例(44.36%)；临床TNM分期为Ⅰ~Ⅱ期418例(81.32%)、Ⅲ~Ⅳ期96例(18.68%)。多因素回归分析结果显示，肿瘤直径≥3 cm、术后远处器官转移、肿瘤低分化、临床分期Ⅲ~Ⅳ期、术后未化疗是非小细胞肺癌患者根治术后预后的影响因素(均P＜0.05)。结论肿瘤直径≥3 cm、术后远处器官转移、肿瘤低分化、临床分期Ⅲ~Ⅳ期、术后未化疗是非小细胞肺癌患者术后预后的独立影响因素，临床应积极开展相关预防干预措施，提高非小细胞肺癌患者术后的生活质量。
- 非小细胞肺癌 /
- 根治术 /
- 临床特征 /
- 预后 /
- 影响因素
Abstract: Objective To explore the clinical characteristics and prognostic factors of patients with non-small cell lung cancer after radical resection, and provide a theoretical basis for the formulation of prognostic intervention programs for patients. Methods A total of 514 patients who underwent radical resection of non-small cell lung cancer in Huzhou Central Hospital from January 2013 to December 2016 were selected as the research subjects. The postoperative clinical characteristics of the patients were counted, and the multivariate regression method was used to analyse the factors affecting the prognosis of patients with non-small cell lung cancer after radical resection. Results The clinical characteristics of 514 patients with non-small cell lung cancer after radical resection showed that the lesions were located in the right lung in 292 cases (56.81%) and in the left lung in 222 cases (43.19%). Histological types were mainly adenocarcinoma in 284 cases (55.25%) and squamous cell carcinoma in 206 cases (40.08%). Meanwhile, 305 cases (59.34%) had postoperative distant organ metastasis. Degree of tumour differentiation: 286 cases (55.64%) with low differentiation, 228 cases (44.36%) with moderate/high differentiation. Clinical TNM staging: 418 cases (81.32%) of stages Ⅰ-Ⅱ and 96 cases (18.68%) of stages Ⅲ-Ⅳ. The results of multivariate regression analysis showed that tumour diameter ≥ 3 cm, distant organ metastasis after the operation, medium/well-differentiated tumour, stages Ⅲ-Ⅳ, and no chemotherapy after operation were the prognostic influencing factors for patients with non-small cell lung cancer after radical resection (all P < 0.05). Conclusion Tumour diameter of ≥ 3 cm, distant organ metastasis after the operation, poorly differentiated tumour, stages Ⅲ-Ⅳ, and no postoperative chemotherapy are independent factors affecting the postoperative prognosis of patients with non-small cell lung cancer. Therefore, relevant prevention should be actively carried out in clinical practice to improve the quality of life of patients with non-small cell lung cancer after radical resection.
- Non-small cell lung cancer /
- Radical resection /
- Clinical features /
- Prognosis /
- Influencing factors

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表 1 514例非小细胞肺癌患者临床特征分析

Table 1. Survey results of clinical characteristics of 514 patients with non-small cell lung cancer after radical resection

项目	类别	例(%)
病变部位	右肺	292(56.81)
	左肺	222(43.19)
肿瘤直径(cm)	＜3	357(69.46)
	≥3	157(30.54)
组织学类型	腺癌	284(55.25)
	鳞癌	206(40.08)
	其他^a	24(4.67)
术后远处器官转移	有	305(59.34)
	无	209(40.66)
肿瘤分化程度	低分化	286(55.64)
	中/高分化	228(44.36)
临床TNM分期	Ⅰ~Ⅱ期	418(81.32)
	Ⅲ~Ⅳ期	96(18.68)
注：^a包括鳞状细胞癌、大细胞癌、肉瘤样癌。

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表 2 非小细胞肺癌患者根治术后预后影响因素的单因素分析[例(%)]

Table 2. Univariate analysis of prognostic factors in patients with non-small cell lung cancer after radical surgery[cases(%)]

项目	类别	预后良好组(n=265)	预后不良组(n=249)	χ²值	P值
性别	男性	193(72.83)	182(73.09)	0.005	0.947
	女性	72(27.17)	67(26.91)
年龄(岁)	＜60	184(69.43)	181(72.69)	0.662	0.416
	≥60	81(30.57)	68(27.31)
病变部位	右肺	150(56.60)	142(57.03)	0.009	0.923
	左肺	115(43.40)	107(42.97)
肿瘤直径(cm)	＜3	153(57.74)	204(81.93)	35.414	< 0.001
	≥3	112(42.26)	45(18.07)
组织学类型	腺癌	135(50.94)	149(59.84)	4.169	0.124
	鳞癌	117(44.15)	89(35.74)
	其他^a	13(4.91)	11(4.42)
术后远处器官转移	有	134(50.57)	171(68.67)	17.448	< 0.001
	无	131(49.43)	78(31.33)
肿瘤分化程度	低分化	132(49.81)	154(61.85)	7.535	0.006
	中/高分化	133(50.19)	95(38.15)
临床TNM分期	Ⅰ~Ⅱ期	243(91.70)	175(70.28)	6.440	0.011
	Ⅲ~Ⅳ期	22(8.30)	74(29.72)
术后化疗	是	189(71.32)	118(47.39)	30.565	< 0.001
	否	76(28.68)	131(52.61)
贫血	有	93(35.09)	105(42.17)	2.713	0.100
	无	172(64.91)	144(57.83)
吸烟史	有	199(75.09)	201(80.72)	2.356	0.125
	无	66(24.91)	48(19.28)
注：^a包括鳞状细胞癌、大细胞癌、肉瘤样癌。

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表 3 各变量赋值方法

Table 3. Variable assignment method

自变量	赋值方法
肿瘤直径	＜3 cm=1；≥3 cm=2
术后远处器官转移	无=1；有=2
肿瘤分化程度	中/高分化=1；低分化=2
临床TNM分期	Ⅰ~Ⅱ期=1；Ⅲ~Ⅳ期=2
术后化疗	是=1；否=2

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表 4 非小细胞肺癌患者根治术后预后影响因素的多因素logistic回归分析

Table 4. Multivariate Logistic regression analysis of prognostic factors in patients with non-small cell lung cancer after radical resection

变量	B	SE	Wald χ²	P值	OR值	95% CI
肿瘤直径≥3 cm	1.200	0.206	33.785	< 0.001	3.319	2.215~4.973
术后远处器官转移	0.762	0.184	17.211	< 0.001	2.143	1.495~3.072
肿瘤低分化	0.491	0.179	7.495	0.006	4.856	1.431~6.878
临床分期Ⅲ~Ⅳ期	0.737	0.295	6.234	0.013	2.089	1.172~7.724
术后未化疗	1.016	0.186	29.843	< 0.001	2.761	1.918~3.974

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