Analysis of Prognostic Factors in 168 Cases of Lung Adenocarcinoma Patients Treated with Targeted Therapy Combined with Chemotherapy

作者: 王真真 , 冯 悦 , 李倩影 , 冯 博 , 王小玉 :承德医学院研究生院,河北 承德; 杨雁鸿 :秦皇岛市第一医院,河北 秦皇岛;

关键词: 肺腺癌预后生存分析靶向治疗Lung Cancer Prognosis Survival Analysis Targeted Therapy

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.

文章引用: 王真真 , 杨雁鸿 , 冯 悦 , 李倩影 , 冯 博 , 王小玉 (2016) 168例肺腺癌患者靶向治疗联合放化疗与其预后因素分析。 亚洲肿瘤科病例研究, 5, 1-13. doi: 10.12677/ACRPO.2016.51001


[1] Yourdon, D.R., Cramb, S.M. and Baade, P.D. (2008) The International Epidemiology of Lung Cancer: Geographical Distribution and Secular Trends. Journal of Thoracic Oncology, 3, 819-831.

[2] Brundage, M.D., Davies, D. and Mackillop, W.J. (2002) Prognostic Factors in Non-Small Cell Lung Cancer: A Decade of Progress. Chest, 122, 1037-1057.

[3] Libby, P. (2002) Inflammation in Atherosclerosis. Nature, 420, 868-870.

[4] Yang, P., Bamlet, W.R., Ebbert, J.O., et al. (2004) Glutathione Pathway Genes and Lung Cancer Risk in Young and Old Populations. Carcinogenesis, 25, 1935-1944.

[5] Yazgan, S., Gursoy, S., Yaldiz, S., et al. (2005) Outcome of Surgery for Lung Cancer in Young and Elderly Patients. Surgery Today, 35, 823-827.

[6] 曹建忠. 局部晚期非小细胞肺癌放疗或化放综合治疗预后因素分析MicroRNA在小细胞肺癌中的预后价值[D]: [博士学位论文]. 北京: 中国协和医科大学, 2009.

[7] Minami, H., Yoshimura, M., Matsuoka, H., et al. (2001) Lung Cancer Treated Surgically in Patients < 50 Years of Age. Chest, 120, 32-36.

[8] Jubelirer, S.J., Varela, N.L., Welch, C.A., et al. (2009) Does Sex Make a Difference in Survival of Patients Undergoing resection for Early Stage Non-Small Cell Lung Cancer (NSCLC)? West Virginia Medical Journal, 105, 18-22.

[9] Moore, R., Doherty, D., Chamberlain, R., et al. (2004) Sex Differences in Survival in Non Small Cell Lung Cancer Patients 1974-1998. Acta Oncologica, 43, 57-64.

[10] 岳东升, 王长利, 张真发, 等. 107例细支气管肺泡癌临床特征及预后分析[J]. 中国肿瘤临床, 2007, 34(9): 515- 518.

[11] 黄彬鋆, 肖静, 吴桂云, 等. 214例肺腺癌患者预后因素分析[J]. 中华疾病控制杂志, 2015, 19(8): 806-810.

[12] Don, R. and Hill, A.B. (1950) Smoking and Carcinoma of the Lung Preliminary Report. British Medical Journal, 2, 739-748.

[13] Wakelee, H.A., Chang, E.T., Gomlez, S.L., et al. (2007) Lung Cancer Incidence in Never Smokers. Journal of Clinical Oncology, 25, 472-478.

[14] 方美玉, 姜初明, 赵亚珍, 等. 无吸烟史肺癌与吸烟相关肺癌临床比较[J]. 中国呼吸与危重监护杂志, 2010, 9(2): 177-180.

[15] Meguid, R.A., Hooker, C.M., Harris, J., et al. (2010) Long-Term Survival Outcomes by smoking Status in Surgical and Nonsurgical Patients with Non-Small Cell Lung Cancer: Comparing Never Smokers and Current Smokers. Chest, 138, 500-509.

[16] (1995) Chemotherapy in Non-Small Cell Lung Cancer: A Meta-Analysis Using Updated Data on Individual Patients from 52 Randomised Clinical Trials. Non-small Cell Lung Cancer Collaborative Group. British Medical Journal, 311, 899-909.

[17] Stephens, R.J., Fairlamb, N., Gower, N., et al. (2002) The Big Lung Trial (BLT): Determining the Value of Cisplatin-Based Chemotherapy for all Patients with Non-Small Cell Lung Cancer (NSCLC). Preliminary Results in the Supportive Care Setting. Proceedings of the Annual Meeting of the American Society of Clinical Oncology, 21, 1161.

[18] 王彩. 319例晚期肺腺癌患者临床预后因素分析[D]: [硕士学位论文]. 河北: 河北医科大学, 2014.

[19] O’Rourke, N., Roqu, I., Figuls, M., et al. (2010) Concurrent Chemoradiotherapy in Non-Small Cell Lung Cancer. Cochrane Database of Systematic Reviews, 16, 140-146.

[20] 杨俊体. 姑息性放疗对IV期非小细胞肺癌预后及生存质量的影响[D]: [硕士学位论文]. 山西: 山西医科大学, 2012.

[21] Nagata, Y., Oro, Y., Aoki, T., et al. (2002) Clinical Outcomes of 3D Conformal Hypofractionated Single High-Dose Radiotherapy for One or Two Lung Tumors Using a Stereotactic Body Frame. International Journal of Radiation Oncology * Biology * Physics, 52, 1041-1043.

[22] Huang, S.F., Liu, H.P., Li, L.H., et al. (2004) High Frequency of Epidermal Growth Factor Receptor Mutations with Complex Patterns in Non-Small Cell Lung Cancers Related to Gefitinib Responsiveness in Taiwan. Clinical Cancer Research, 10, 8195-8203.

[23] Mok, T.S., Wu, Y.L., Thongprasert, S., et al. (2009) Gefitinib or Carboplatin-Paclitaxel in Pulmonary Adenocarcinoma. The New England Journal of Medicine, 361, 947-957.

[24] Jenab-Wolcott, J. and Giantonio, B.J. (2009) Bevacizumab: Current Indicationgs and Future Development for Management of Solid Tumors. Expert Opinion Biological Therapy, 9, 507-517.

[25] 王竞, 夏廷毅, 王颖杰等. 靶向药物同步个体化放疗晚期/转移性非小细胞肺癌的Ⅱ期临床试验[J]. 癌症进展. 2011, 1(9): 94-101.