早发生和晚发生非小细胞肺癌的临床分析

目的 分析早发生（EOLC：年龄≤50岁）和晚发生（LOLC：年龄≥70岁）非小细胞肺癌病人的临床特点，表皮生长因子受体（EGFR）、肿瘤血管生成因子（VEGF）、P21、P53、CerbB2表达状况以及与发生早晚的相关性。方法 采用病例平行对照研究分析2005年6月～9月初治的术前评估可完全手术切除的原发性非小细胞肺癌中早发生48例晚发生52例的临床特点，分子生物学表达状况，统计方法为卡方及t检验和Logistic逐步回归分析。结果 LOLC和EOLC中从不吸烟分别是38．5％和25％，被动吸烟13．5％和35．4％，吸烟48．0％和39．6％；P=0．03；LOLC和EOLC的肿瘤家族史分别为9．6％和29．2％，P=0．01；LOLC和EOLC中EGFR阳性分别是32．7％和62．5％；P=0．003；LOLC和EOLC中FVC分别是94．54±14．30和104．29±15．59；P=0．002；FEV1分别是87．73±14．97和95．83＋14．07，P=0．01。Logistic回归分析显示：肿瘤家族史和EGFR阳性表达增加了EOLC组风险，RR：3．87（1．27-11．77）和3．43（1．51-7．81）。EOLC组FVC的RR为1，LOLC组FVC的RR为095（0．92—0．98）。结论 早发生和晚发生非小细胞肺癌在吸烟状态、家族肿瘤病史、EGFR表达、肺功能上存在差异。其中尤以肿瘤家族史和EGFR阳性、肺功能的差异有统计学意义。

Clinical analysis of early onset and late onset non-small cell lung cancer

Objective To examine clinical characteristics and expressions of oncoproteins （EGFR, VEGF, P21, P53 and CerbB2） in early onset （≤ 50 years at the time of diagnosis） lung cancer （EOLC） patients and late onset （≥ 70 years at the time of diagnosis） lung cancer （LOLC） patients, and analyze their correlation with EOLC or LOLC. Methods In this case parallel control study, 48 patients were screened as EOLC and 52 patients as LOLC from all patients who were preoperatively assessed as having primary non-small cell lung cancers that were preoperatively assessed as completely respectable on initial visits between June and September 2005. Their clinical characteristics and molecular biological expressions were statistically analyzed by X2, independent samples t test and logistic regression. Results The percentage of non smokers, passive smokers and smokers in LOLC and EOLC was 38.5 % vs 25 %, 13.5 % vs 35.4% and 48% vs 39.6% （P=0.03）, respectively. Family cancer histories were elicited in 9.6% of LOLC and 29.2% in EOLC （P=0.01）. Positive EGFR expression was found in 32.7% of LOLC and 62.5% in EOLC （P=0.003）. Mean FVC was 94.54± 14.30 in LOLC and 104.29 ± 15.59 in EOLC （P=0.002）. Mean FEV1 was 87.73 ± 14.97 in LOLC and 95.83 ± 14.07 in EOLC （P=0.01）. Logistic regression showed that the family cancer history and EGFR expression increased the risk of EOLC patients, where RR was 3.87 （ 1.27-11.77 ） and 3.43 （ 1.51-7.81 ） respectively. RR of FVC in LOLC patients was 0.95 （0.92-0.98）. Conclusion There are differences in the smoking status, family cancer history, EGFR expression and lung function between early onset and late onset non-small cell lung cancers, of which a positive family cancer history, positive EGFR expression and poor lung function are statistically significant.