不同年龄晚期非小细胞肺癌患者的临床特点分析

目的探讨不同年龄晚期非小细胞肺癌(NSCLC)患者的临床特点、治疗方法及预后因素。方法回顾性分析128例晚期NSCLC患者的临床资料,根据年龄分为老年组(86例)和青年组(42例)。分析比较两组患者的临床特点、治疗方法及治疗后的生存状况。结果老年组患者的年龄为(72.10±0.21)岁,青年组患者的年龄为(36.34±0.13)岁。青年组中女性吸烟患者占42.9%,高于老年组女性患者(19.8%),差异有统计学意义(P<0.05)。老年组患者罹患心血管疾病、呼吸系统疾病、消化系统疾病和糖尿病者分别为55.8%、43.0%、46.5%和39.5%,高于青年组(分别为11.9%、19.0%、21.4%和9.5%),差异有统计学意义(P<0.05)。老年组男性患鳞癌比例(26.7%)高于青年组(9.5%),青年组女性腺癌患者比例(33.0%)高于老年组(12.8%),差异有统计学意义(P<0.05)。老年组患者治疗方式以放化疗方式为主(分别为75.6%和16.7%),而青年组患者以手术切除方式为主(分别为83.0%和19.8%),差异有统计学意义(P<0.05)。老年组患者1、3和5年生存率分别为64.3%、47.5%和29.9%,青年组分别为74.3%、53.5%和36.9%,差异均无统计学意义(P>0.05)。结论青年组非小细胞肺癌患者女性多见,肺腺癌所占比例较大,接受手术治疗的比例大。而老年组患者则肺鳞癌所占比例大,伴有其他系统疾病多见。青年和老年非小细胞肺癌患者的预后差异不大。     

青年人肺癌与老年人肺癌的病理类型与外科治疗

 本文就我院纤支镜检,并经病理和或细胞学确诊之青年人肺癌251例、老年人肺癌409例进行对照分析。从性别年龄构成比可见女性随年龄增高而相对减少,所以,老年人肺癌男性最多,青年人肺癌女性相对为多。从病理类型构成比可见鳞癌随年龄增高而相对增多;小细胞癌则相对减少。所以,老年人肺癌鳞癌最多;青年人肺癌小细胞癌相对为多。青年组术后随访1年以上70例;老年组124例。青年组术后生存率最低、老年组最高。     

吉西他滨联合顺铂治疗老年晚期非小细胞肺癌研究

目的比较吉西他滨联合顺铂方案对老年非小细胞肺癌和非老年非小细胞肺癌的疗效和毒副作用的区别。方法 采用吉西他滨联合顺铂3周方案治疗晚期老年非小细胞肺癌35例, 同期非老年35例作为对照, 观察近期疗效和毒副作用。结果 老年组伴随疾病发生率、化疗前评分及完成化疗周期数较非老年组为高;有效率45.7%∶51.4%, 中位生存时间9.0月∶9.2月, 一年生存率38.2%∶40.6%均无显著性差异;毒副作用也无显著性差异。结论 吉西他滨联合顺铂3周方案对于老年非小细胞肺癌是一个比较安全的选择。     

青年人与老年人肺癌手术治疗结果的对比分析

采用ＳＴＡＴＡ５．０统计软件对１１１例≤４０岁的青年人及５３例≥７０岁老年人肺癌的外科治疗病历建立数据库并进行统计分析。总结治疗结果,探讨其临床及影响预后因素的差异。２组间一般临床结果差异的显著性检验用卡方检验,生存率用寿命表法计算,生存率差异显著性检验用Ｌｏｇｒａｎｋ检验。结果显示：青年组与老年组胸痛、气短症状发生率分别为４６．０％与１８．９％、４６．０％与２８．３％;小细胞癌的比例分别为１８．９％与５．７％;全肺切除率分别为２１．６％与３．８％。青年组与老年组鳞癌、Ⅰ期病变的５ａ生存率分别为５３．５％与２０．９％、６１．６％与５２．０％。结果表明：青年组胸痛、气短症状发生率,小细胞癌的比例及全肺切除率均显著地高于老年组。青年组鳞癌及Ⅰ期病变的５ａ生存率均显著地高于老年组     

纤支镜检查青年人肺癌304例

本文报道青年人(<40岁)肺癌304例纤支镜检查。以同时期检查之中,老人肺癌为对照组。本文病例均经病理或细胞学确诊。青年组鳞癌占37.8％(115/304);中年组占46.9％(507/1082);老年组占52.7％(259/491)。差异有高度显著性(x~2=16.78,P<0.001)。 小细胞癌青年组占27.0％;中年组占20.4％;老年组占14.5％。差异有高     

中晚期非小细胞肺癌年龄因素对化疗疗效的影响

中晚期的非小细胞肺癌常以姑息性化疗为主。在以ＤＤＰ为主的联合化疗中 ,我们注意到非小细胞肺癌年龄因素对化疗疗效存在着一定的影响 ,有较重要的临床意义。临床资料 :病例组 :1995年 1月至 1997年 1月间经病理或细胞学证实的病人 ,其中男性 6 2例 ,女性 18例 ,年龄 2 3～ 78岁 ,鳞癌 5 1例、腺癌 2 2例、腺鳞癌 7例。根据 1989年国际肺癌ＴＮＭ分期标准 ,ⅢＡ 期 6 8例 ,ⅢＢ 期 12例。对照组 :分为老年和中青年组各 40例 ,老年组年龄为 6 0岁以上 ,中青年组为 5 9岁以下 ,最小 2 3岁。入组标准 :经病理或细胞学确诊为非小细胞肺癌 ;国际…     

青年组与老年组舌鳞癌比较分析

目的 对舌鳞癌患者，青年组和老年组的临床过程和结果方面进行探讨。方法 对40岁以下（青年组）和60－70岁（老年组）各23例的舌鳞患者在五年生存率和复发情况进行比较。结果 五年生存率青年组为68％；老年组为74％。局部复发率青年组为30％；老年组为14％。区域复发率青年组为26％；老年组为18％。统计学上老年显著性差异。结论 青年组有较高的局部区域复发率，但在生存率方面是没有差异。     

多西他赛周给药治疗老年晚期非小细胞肺癌30例

[目的]观察多西他赛单药周给药一线治疗老年晚期非小细胞肺癌的临床疗效。[方法]30例老年晚期非小细胞肺癌初治患者予以多西他赛35mg／m^2，于第1、8d给药，每21d为1个周期。[结果]30例可评价病例中，完全缓解1例，部分缓解7例，总有效率为26．3％，中位无进展生存期3．5个月，中位生存期7．8个月，1年生存率33．3％。毒副反应以粒细胞减少、乏力、脱发为主。[结论]多西他赛单药周给药一线治疗老年晚期非小细胞肺癌是安全有效的。     

老年肺癌病人的临床分析

目的　探讨老年肺癌病人的临床特点。方法　回顾性分析 113例老年肺癌病人 (6 5岁以上 )的临床特点 ,并分析不同年龄组发病时的首发症状 ,中位生存期及不同分期接受不同治疗后的生存期比较。结果　鳞癌占 5 0 .4 % ,腺癌占 36 .3% ,其他非小细胞癌占 7.1% ,小细胞癌占 6 .2 %。 4 7.8%患者在健康普查时发现。因咳嗽、咳痰就诊占 2 3% ,以咯血为首发症状占15 .9%。高龄老年肺癌组 (80～ 90岁 )中 5 3.9%的患者采用免疫治疗或未治 ,显著高于非高龄老年肺癌组 (P <0 .0 1)。仅12 .8%的患者手术 ,也明显低于非高龄老年组 (P <0 .0 1)。 6 4 %的患者生存期在 1年或 1年以内 ,平均生存 11月。 5年生存率仅 6 .9%～ 18.8%。高龄老年组 5年生存率仅 12 .8%。各组之间同期肺癌中位生存期比较均无显著差异 (P >0 .0 5 )。高龄老年肺癌组Ⅲ～Ⅳ期治疗与否 ,生存期并无显著改善 (P >0 .0 5 )。结论　老年肺癌主要为男性病人 ,且半数为鳞癌。首发症状不典型 ,早期诊断较困难。晚期老年肺癌患者不宜采取积极的治疗 ,以支持治疗为主 ,尽量减少患者的痛苦 ,提高生活质量。     

组织学类型对晚期非小细胞肺癌治疗决策的影响

原发性支气管肺癌简称肺癌,组织病理学上主要分为两大类,即非小细胞肺癌(non-small cell lung carcinoma,NSCLC)和小细胞肺癌。前者占肺癌中的80%。世界卫生组织将NSCLC分为鳞癌、腺癌、大细胞癌、腺鳞癌,及伴有多行性、肉瘤样或肉瘤成分癌等[1]。腺癌是目前发病率最高的类     

Non Small Cell Lung Cancer in the Elderly: Clinico-Pathologic,Management and Outcome Characteristics in Comparison to Younger Patients

Abstract

It is controversial whether non-small cell lung cancer (NSCLC) in the elderly constitutes a distinct clinico-biological entity compared to younger counterparts. As reported data are scant and discordant, we sought to analyze retrospectively the medical records of Hellenic NSCLC patients aged >70 years and compare them with those of age (70-45 years) and younger (<45 years) patients. Records were abstracted from the Hellenic Cooperative Oncology Group (HECOG) cancer registry database. Presentation, management and outcome data of 417 elderly patients aged ≥70, 1374 age 70-45 years old and 115 patients aged ≤45 years old with histologically confirmed NSCLC managed from 1989 until 2004 were retrieved and compared. Elderly patients differed significantly in terms of presence of symptoms (p<0.001), including thoracic pain(p=0.003), dyspnea (p<0.001), cough (p<0.001) and fatigue (p≥1), eastern Co-operative Oncology Group performance status (PS) 2-3 (p≥1), and histological type (more commonly diagnosed with squamous cell carcinoma (p<0.002) and less frequently with adenocarcinoma). Although elderly patients had significantly higher rates of PS 2-3, they had significantly better median time to disease progression (TTP) com-pared to the younger counterpart (6.4 versus 4.3 months p=0.047). Overall survival (OS) was not significantly different between elderly and young patients (median OS11.8 versus 11.5 months; p=0.6), but platinum-based chemotherapy and radiotherapy were variables associated favorably with TTP and survival in the elderly. this large retrospective series presents strong evidence that NSCLC constitutes a similar clinico-pathologic entity in elderly and young individuals with discretely differing biological behavior and that elderly symptomatic patients should be considered for effectiveanticancer treatment whenever possible.     

晚期非小细胞肺癌患者靶向治疗效果及血清肿瘤标志物变化分析

目的 探讨血清肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19片段(CA211)与晚期非小细胞肺癌(NSCLC)患者靶向治疗效果及预后的关系.方法 选取晚期NSCLC患者82例,所有患者均接受靶向药物治疗,治疗结束后评价近期疗效,并在治疗前及治疗后2个月对患者血清CEA与CA211水平进行检测,比较不同组织学类型晚期NSCLC患者血清CEA、CA211水平,分析治疗前后不同疗效晚期NSCLC患者血清CEA、CA211水平,并分析血清CEA、CA211水平与晚期NSCLC患者生存期的关系.结果 82例患者靶向治疗的总有效率为43.90％;腺癌患者血清CEA水平明显高于鳞癌患者(P﹤0.01),CA211水平明显低于鳞癌患者(P﹤0.01);治疗后,PR组患者血清CEA、CA211水平均较治疗前降低(P﹤0.05);治疗后,PR组患者血清CEA、CA211水平均低于治疗后SD、PD组患者(P﹤0.05);治疗后,PD组患者血清CEA、CA211水平均较治疗前升高(P﹤0.05).血清CEA水平﹤15 ng/ml、血清CA211水平﹤5 ng/ml患者的PFS大于血清CEA水平≥15 ng/ml、血清CA211水平≥5 ng/mL的患者(P﹤0.05).结论 不同近期疗效晚期NSCLC患者血清CEA、CA211水平存在较大差异,血清CEA、CA211水平对预测晚期NSCLC患者靶向治疗效果及预后具有重要的参考价值.     

A retrospective analysis comparing patients 70 years or older to patients younger than 70 years with non-small-cell lung cancer treated with surgery at Indiana university: 1989-1999

Surgery remains the cornerstone of therapy for medically operable patients with early-stage non-small-cell lung cancer (NSCLC). However, there are few reports on the short-term morbidity and long-term survival following surgery in elderly patients with NSCLC. The surgical experience in 280 patients with NSCLC at Indiana University from 1989-1999 are reported with a comparison of patients who are >or= 70 years versus < 70 years of age. Preoperative characteristics, operative procedures, postoperative courses, and survival were compared between the age groups. Fifty percent of elderly patients had squamous cell carcinoma and 36.2% had adenocarcinoma, versus 41.3% and 44.4% in younger patients, respectively. In both groups, most patients had T1 or T2 tumors and N0 disease. The majority of patients in both age groups had a lobectomy. However, more patients younger than 70 years had chest wall resections and were more likely to undergo a pneumonectomy (19.5% vs. 6.9%). The median number of postoperative hospital days was shorter for younger patients (9 days vs. 11 days). Overall, more complications occurred in older patients, but no significant difference in cardiac or pulmonary complications was observed between the groups. There was no significant difference in survival between the age groups. This single-institution series demonstrates that surgical intervention for appropriately selected elderly patients with NSCLC results in similar complication rates and long-term survival when compared to their younger counterparts.     

Cisplatin-based combination chemotherapy for elderly patients with non-small-cell lung cancer

Purpose: To compare the response rates, toxicities and survival durations of elderly patients (70 years of age or more) with those of younger patients ( less than 70 years of age) with non-small-cell lung cancer (NSCLC) treated with cisplatin-based chemotherapy. Patients and methods: We analyzed retrospectively the data of 203 assessable patients entered on a prospective randomized trial of cisplatin-based combination chemotherapy. Chemotherapy consisted of three dosage regimens: (1) vindesine and cisplatin (VP); (2) mitomycin, vindesine and cisplatin (MVP); or (3) etoposide and cisplatin alternating with vindesine and mitomycin (EP/VM). Results: A greater proportion of elderly patients had localized disease and more squamous cell carcinoma than non-elderly patients. The overall response rates were 44% in the elderly group and 28% in the non-elderly group. In the EP/VM arm, the response rate was significantly better in the elderly group than in the non-elderly group. The frequency of grade 4 leukocytopenia in the MVP and EP/VM arms in the elderly group was significantly greater than in the non-elderly group (P < 0.05). No differences were found in nonhematological toxicities between the two groups. There was no difference in overall survival between the groups. Conclusion: Elderly patients treated with mitomycin-containing regimens have higher hematologic toxicities than younger patients. The results of this study are consistent with the previously reported pharmaco logic data on mitomycin suggesting altered pharmacokinetics in elderly patients. The improved response rate in the elderly patients was probably because more elderly patients had earlier disease, squamous cell carcinoma and better performance status. Cisplatin-based chemotherapy was tolerable for most elderly NSCLC patients with good performance status. Received: 30 October 1996 / Accepted: 20 March 1997     

721例非小细胞肺癌临床病理学特征分析

目的：研究非小细胞肺癌（non －small cell lung cancer,NSCLC）患者临床特征、影像学征象、支气管镜下表现与病理类型的关系。方法：收集2009年1月至2014年12月我院721例 NSCLC 患者的临床资料。利用 SPSS 13．0统计软件进行分析。结果：在721例 NSCLC 患者中,男女比例为3．65∶1。鳞癌是最常见病理类型（57．00％）,男性患者中鳞癌比例最高,女性患者中腺癌比例最高（P ＜0．01）。平均发病年龄为（59．72±0．54）岁;40岁以下患者占比低（3．61％）,其中腺癌比例明显高于鳞癌。非吸烟患者中腺癌比例最高（68．45％）;吸烟者中鳞癌比例最高（65．92％）,特别是吸烟指数大于400的患者鳞癌比例更高。临床症状以咳嗽、咳痰、咯血或痰中带血、胸闷气短最为常见,无明显症状体征少（5．13％）。肺部肿块影（66．30％）仍是NSCLC 的主要影像学征象。NSCLC 在支气管镜下多表现为外向型生长（47．43％）。NSCLC 支气管镜及影像学特点相结合,支气管镜下鳞癌的外向型生长明显高于腺癌。在影像学特征中,腺癌肿块影、阻塞性肺炎、胸腔积液、毛刺征／分叶征出现率明显高于鳞癌。结论：NSCLC 在中老年患者中高发,对于有咳嗽、咳痰、咯血或痰中带血、胸闷气短等症状及吸烟患者尤应引起重视。常规检查仍推荐影像学（胸部 CT 等）及支气管镜进行筛选。仔细分析患者症状及影像学结果,进行有针对性的检查和病理活检,可能使患者诊断时间缩短,得到及时治疗。     

小于30岁低龄肺癌患者的临床分析

背景与目的青年肺癌患者肿瘤恶性程度高,侵袭性强,预后差,已成为多数共识。既往对青年肺癌患者的研究多以40岁或45岁为界,而<30岁的低龄肺癌患者临床资料少见报道。本文回顾分析了解放军总医院从1993年至今17年来诊疗过的<30岁的低龄肺癌患者的病史、分期、治疗及病理特点,为这一年龄段肺癌患者的诊疗提供参考。方法检索解放军总医院收治的1993年以来所有<30岁的肺癌患者,共计53例。其中非小细胞癌患者34例,小细胞癌患者19例。男女比例1.5:1。非小细胞肺癌患者中,腺癌27例,鳞癌6例,腺鳞癌1例,无大细胞癌患者。其中12例接受手术治疗,38例化放疗,3例放弃治疗。结果全组无住院死亡病例,12例手术患者中,手术根治性切除8例,姑息性切除4例。结论低龄肺癌患者腺癌,小细胞癌比例大,多数出现症状就诊时处于晚期,预后差。改善预后应重视常规体检,早期诊断。     

老年食管鳞状细胞癌的放疗疗效及预后因素分析

目的:探讨老年食管鳞状细胞癌的临床特点、放疗疗效及其预后的相关因素。方法:回顾性分析2003年1月至2008年1月在我院接受放射治疗的299例食管鳞状细胞癌患者的临床资料,运用SPSS 16.0软件分析生存率及预后的影响因素（＜65岁为非老年组,≥65岁为老年组）。结果:老年组和非老年组总有效率分别为56.0%、91.3%（P=0.000）。老年组患者的近期疗效与化疗史（P=0.001）和放疗剂量（P=0.005）有关,非老年组的近期疗效与患者的民族有关（P=0.001）。而性别、吸烟史、饮酒史、病变长度、病变部位、临床分期、分化程度、淋巴结转移、KPS评分等临床因素与近期疗效无明显相关性（P均＞0.05）。老年组和非老年组患者的中位生存时间分别为42个月、41个月,经Log-Rank检验,两组患者生存时间的差异无统计学意义（P=0.954）。多因素分析显示放疗剂量≥60Gy的老年食管鳞癌患者预后比放疗剂量＜60Gy的患者好（P=0.023,95%CI:0.432~0.939）,放疗近期疗效达缓解的患者比近期疗效无缓解的患者预后好(P=0.001,95%CI:1.339~2.885);而放疗方式、化疗史、病理分型与预后无相关性（P均＞0.05）。结论:非老年组的放疗近期疗效优于老年组;老年组的近期疗效与化疗史、放疗剂量有关;放疗剂量≥60Gy、近期疗效达缓解的老年食管癌患者预后相对较好。     

Comparison of Survival of Patients With Lung Cancer Between Elderly (greater double equals70) and Younger (70>) Age Groups

Results of radiotherapy for lung cancer in the elderly werecompared with those in younger patients. A total of 129 patientswere treated by radiation therapy with or without chemotherapy.Fifty-six patients (43.4%) were 70 years old or more (elderlygroup) at the time of treatment, and the remaining 73 patientswere below age 70 (younger group). Treatment results in the elderly group were nearly the sameas those in the younger group in all stages of the disease.Survival time was longer for patients with performance status(PS) of 0 to 2 than for those with PS 3 or 4 regardless of age(p < 0.05). The survival time of the elderly group was nearlythe same as that of the younger group for squamous cell carcinoma,but somewhat shorter for adenocarcinoma although the differencewas not statistically significant. There was no difference insurvival between the two groups when they were treated by combinedradiation therapy and chemotherapy. Our results suggest thatelderly patients can be treated as safely as younger patientsby radiotherapy alone or combined radiation therapy and chemotherapy.     

GT 方案治疗老年晚期非小细胞肺癌的临床疗效观察

目的：观察 GT 方案治疗老年晚期非小细胞肺癌（NSCLC）的临床疗效和安全性。方法60例老年晚期老年晚期 NSCLC 患者接受化疗：吉西他滨1000 mg·m -2，静脉滴注，d1，8；多西他赛60 mg·m -2，静脉滴注，d1，每21 d 为1周期，至少应用2周期后评价疗效。结果60例患者中，CR 5例，PR 14例，SD 17例， PD 24例，总有效率为31.7％（19/60），初治组有效率为37.8％（14/37），复治组有效率为26.1％（6/23）；腺癌有效率为36.7％，鳞癌有效率为36.3％；初治与复治、不同的病理类型间有效率比较差异均无统计学意义（P ﹥0.05）。主要毒副反应为骨髓抑制。结论 GT 方案在老年晚期 NSCLC 患者的应用中安全有效，值得进一步研究。     

Clinical effect of erlotinib as first-line treatment for Asian elderly patients with advanced non-small-cell lung cancer

Purpose

To evaluate the efficacy and toxicities of erlotinib as first-line treatment for Asian elderly patients with advanced non-small-cell lung cancer (NSCLC).

Patients and methods

Untreated patients with advanced NSCLC were included in this study; erlotinib was orally administered at a dose of 150 mg daily until disease progression or intolerable toxicity or for other reasons.

Results

A total of 35 patients were enrolled. Patient characteristics were as follows: mean age 75.6 years (ranged 70–81 years), 24 (68.6%) male, 16 (45.7%) former or current smokers, 13 (37.1%) adenocarcinoma, 18 (51.4%) squamous cell carcinoma and 4 (11.4%) bronchioloalveolar carcinoma. Out of 35 patients, 1 CR, 16 PR and 10 SD, resulting in an overall response rate (CR + PR) of 48.6% and disease control rate (DCR = CR + PR + SD) of 77.1%. The median TTP was 6.4 months, and the median OS was 12.7 months. The CBR was 80%, and the 1-year survival rate was 48.6%. The most common adverse event (AE) was mild skin rash and diarrhea (CTC AE 1/2). Among them, the female never smokers with a non-squamous cell carcinoma histology was superior to the male smokers with a squamous cell carcinoma in disease control rate, with significant differences (P < 0.05).

Conclusion

The results suggest that erlotinib monotherapy is an effective and well-tolerated treatment option for Asian elderly patients with advanced NSCLC.