1980—1993年广东省中山市肺癌患者生存分析

目的：探讨1980—1993年中山市肺癌患者生存情况及其影响因素，为肺癌防治提供科学依据。方法：对1980—1993年中山市肿瘤登记资料中肺癌患者的生存情况及其影响因素进行分析。结果：患者年龄、确诊依据、确诊时间、确诊单位及治疗方式是影响肺癌患者生存率的因素，其中经病理诊断、手术治疗及省级医院确诊的肺癌患者生存率相对较高。结论：提高肺癌患者生存率的关键在于早期诊断、病理确诊与尽可能手术治疗。     

外科治疗70岁以上老年肺癌患者的预后因素分析

背景与目的随着手术和麻醉技术的提高,越来越多的老年肺癌患者接受手术治疗。本研究的目的是探讨70岁以上老年肺癌患者术后生存情况及其影响因素,为老年肺癌的治疗提供依据。方法回顾性分析192例手术治疗的70岁以上老年肺癌患者的术后生存情况,采用单因素和多因素方法分析各种预后因素的影响度。结果全组总的5年生存率为33.5%。手术方式、手术性质、病理类型及分期均可显著影响患者的预后,其中后三者为独立预后因素。结论老年肺癌患者术前应全面检查,尽量避免单纯探查手术和姑息手术。手术以肺叶切除为标准术式,某些特殊情况下,也可行部分肺叶切除术。     

117例小细胞肺癌患者临床特征与预后分析

目的:分析小细胞肺癌患者临床特征和影响其预后的因素。方法:收集 2007年 7 月至 2010 年7 月淄博市第一医院收治的经病理组织学证实、有完整随访资料的 117例小细胞肺癌患者的临床资料。回顾性分析小细胞肺癌患者临床特征、复发及生存情况。单因素分析采用Kaplan-meier法生存分析,进行Log-rank非参数检验,多因素分析采用Cox 回归分析。结果:全组1年生存率为71.8%,2年生存率为35.9%,3年生存率为12.8%。局限期1年生存率为76.9%,2年生存率为46.2%,3年生存率为19.2%;广泛期1年生存率为61.5%,2年生存率为15.4%,3年生存率为0,两者差异有统计学意义(P=0．000)。全组中位生存时间20个月,局限期中位生存时间22个月,广泛期中位生存时间12个月,两者差异有统计学意义(P=0．000)。单因素分析发现年龄、分期、化疗周期数、治疗方式均可影响患者的生存时间。多因素分析提示分期、治疗方式是影响小细胞肺癌预后的主要因素。结论:分期、治疗方式是小细胞肺癌的独立预后因素,应争取早诊断、早治疗（采用放化疗、手术等综合治疗方式）。     

2010年—2015年新疆医科大学附属肿瘤医院肺癌住院患者生存分析

目的:对肺癌住院患者随访资料进行多因素预后分析,找出影响肺癌患者预后的相关因素。方法:建立2010年—2015年肺癌患者随访数据库。采取门诊复查、住院复查及电话随访的方式,对3 709例肺癌患者进行随访,了解其生存情况。利用Kaplan-Meier 法计算生存率并绘制生存曲线,采用Cox 回归模型进行影响肺癌患者预后的多因素分析。结果:3 709例肺癌患者中, 1年、2年、3年、5年生存率分别为59.2%、35.4%、26.3%、18.0%。单因素分析表明:性别、民族、治疗方式、病理类型、是否转移、TNM分期与生存率有关(P＜0.05)。Cox模型多因素分析表明:性别、治疗方式、病理类型、是否转移、TNM分期是预后的独立影响因素。结论:性别、治疗方式、病理类型、是否转移、TNM分期是影响肺癌疗效和预后的重要因素。     

1380例手术后的非小细胞肺癌的多因素预后分析

背景与目的 非小细胞肺癌的预后影响因素较多。本研究旨在结合临床资料对非小细胞肺癌术后的预后及其影响因素进行分析。方法 回顾性分析自1996年1月至2003年1月1380例手术治疗的非小细胞肺癌患者的资料，对影响其预后的临床病理因素进行了单因素及多因素分析。结果 全组1、3、5年生存率分别为78．85％、49．78％和38．96％，中位生存时间38．77月。单因素分析显示患者肿瘤大小、病理类型、临床类型（中心型和周围型）、病理分期、淋巴结转移情况、手术方式、术后是否化疗及化疗周期数是影响预后的因素，多因素分析显示肿瘤大小、病理分期、淋巴结转移情况及术后是否化疗和化疗的周期数是影响预后的独立因素。结论 对于手术治疗的非小细胞肺癌患者，肿瘤大小、病理分期、淋巴结转移情况及术后化疗情况是独立的预后因素。     

非小细胞肺癌脑转移放射治疗的预后因素分析

背景与目的脑转移最常见于肺癌患者,放射治疗是其有效的常规治疗手段。目前的治疗以姑息止痛和减轻症状为目的,方法差异较大,对肺癌脑转移预后的认识也不尽相同。本研究旨在分析非小细胞肺癌脑转移患者放射治疗的疗效以及影响生存率的预后因素并建立预后模型。方法回顾性分析1995年2月-2006年10月在我科接受全脑放射治疗的82例非小细胞肺癌脑转移患者的临床资料,采用Kaplan-Meier法计算生存率,各亚组生存率差别的比较采用log-rank时序检验,分析影响生存预后的各种因素(单因素和多因素分析),以Cox回归分析获得的有统计学意义的因子组成预后模型。结果随访时间为1-120个月,全组患者诊断脑转移后的中位生存期为10.5个月,6个月、1年和2年的总生存率分别为50.8%、23.7%和5.1%。单因素和多因素分析均显示放射治疗前KPS评分、肺原发肿瘤控制情况、确诊肺癌到脑转移间隔时间、脑转移灶数目是影响生存的独立预后因素,根据上述因素建立预后指数将82例患者分成预后好、中和差三组,其生存曲线的差异有统计学意义(P<0.001)。结论KPS评分、确诊肺癌到脑转移间隔时间、肺原发肿瘤控制情况、脑转移灶数目是影响非小细胞肺癌脑转移放射治疗生存的独立预后因素,预后指数模型能很好地反映预后。     

66例广泛期小细胞肺癌患者预后分析

目的:分析广泛期小细胞肺癌的独立预后因素。方法:回顾性分析安阳市肿瘤医院2005年7月至2009年7月治疗的66例广泛期小细胞肺癌的临床资料,所有患者均经组织病理或细胞学确诊。生存分析采用Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析,并对有意义的单因素通过COX风险模型筛选影响预后因素。结果:广泛期患者1、2、3年生存率分别为40.9%、13.6%、6.1%,中位生存时间为10个月。单因素分析显示体重减轻情况、一线化疗疗效、总化疗周期数、治疗方式、低钠血症与患者预后相关,具有统计学差异。多因素分析显示一线化疗疗效、总化疗周期数、低钠血症对患者的总生存时间具有显著影响。结论:一线化疗疗效、总化疗周期数和低钠血症是影响广泛期小细胞肺癌的独立预后因素。     

467例小细胞肺癌患者的预后分析

目的:肺癌发病率逐年上升,死亡率居癌症之首,其中小细胞肺癌恶性程度最高.本研究旨在分析小细胞肺癌的独立预后因素.方法:回顾性分析解放军总医院2005年1月至2009年12月经组织病理或细胞学确诊的467例小细胞肺癌患者,对可能影响其预后的相关因素进行单因素和多因素分析.结果:局限期患者1、2、3年生存率分别为81.72%、54.95%、41.09%,中位生存时间为27个月.广泛期患者1、2、3年生存率分别为66.81%、25.77%、17.06%,中位生存时间为17个月.单因素分析显示年龄、临床分期、是否肝转移、是否手术、化疗、放疗、一线化疗疗效、一线化疗周期数、初治时血红蛋白水平、LDH值、NSE值及CY-FRA21-1值与患者预后相关(P<0.05).多因素分析显示是否放疗、总周期数、一线化疗疗效和CYFRA21-1对患者的生存时间有显著影响.结论:是否放疗、化疗总周期数、一线化疗疗效和初治时CYFRA21-1水平是影响小细胞肺癌的独立预后因素.     

高龄肺癌患者外科治疗60例

总结60例高龄肺癌患者的手术疗效。其手术切除率86.7%，手术死亡率1．7％，5年生存率为32.4％。与同期582例肺癌手术治疗的5年生存率差异无显著性(P＞0．05)。影响木后生存的主要因素是病理分期，I期显著优于Ⅲ期(P＜0．005)，对高龄肺癌患者．只要有切除和长期生存希望的应积极争取手术治疗。     

子宫内膜癌预后因素的Cox回归分析

目的:探讨影响子宫内膜癌预后的相关危险因素。方法:回顾分析110例子宫内膜癌患者临床资料,对年龄、子宫内膜家族史、手术-病理分期、病理类型、组织学分级、淋巴结转移、治疗方式等因素进行单因素和多因素分析。采用 Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析及各组生存率曲线分布比较,Cox回归模型进行多因素分析。结果:110例子宫内膜癌患者的生存时间为2-133个月,中位生存时间52.4个月,因子宫内膜癌死亡者24例(21.8%)。1、3、5年总体生存率分别为95.4%、85.5%、78.2%。单因素分析表明:不同病理类型、手术-病理分期、肿瘤大小、淋巴结转移、组织学分级、治疗方式的生存率差异有统计学意义（P＜0.05）。Cox风险比例回归模型进行多因素分析结果显示病理类型、手术-病理分期、组织学分级、淋巴结转移、治疗方式是影响子宫内膜癌预后的独立因素。结论:病理类型、手术-病理分期、组织学分级、淋巴结转移、治疗方式是影响子宫内膜癌预后的独立因素。     

广东省中山市1975-1999年肺癌发病动态分析

目的 :探讨广东省中山市 1975 - 1999年肺癌发病状况及其规律 ,为中山市肺癌防治提供科学依据。方法 :整理 1975 - 1999年中山市肿瘤登记资料中的肺癌发病资料 ,计算并分析其发病数、发病粗率、中国及世界标化发病率等。结果 :1975 - 1999年中山市肺癌发病率有明显上升趋势 ;1990 - 1999年中山市肺癌发病粗率为 16 4 9 10万 ,中国标化发病率为 14 89 10万 ,世界标化发病率为 19 73 10万。结论 :虽然 1975 - 1999年中山市肺癌发病率居国内外中下水平 ,但上升速度较快 ,应进一步探讨致病原因 ,以控制其危害性     

The changing epidemiology of lung cancer in Europe

BACKGROUND: Since the incidence and mortality of the histological subtypes of lung cancer in Europe has changed dramatically during the 20th century, we described the variation and changes in incidence, treatment modalities and survival of lung cancer. METHODS: For geographical variation and changes in incidence, data of the European cancer incidence and mortality (EUROCIM) database were used, and data on survival were derived from the EUROCARE database. For trends in treatment modalities and survival, according to histology and stage, data of the Eindhoven Cancer registry were used. RESULTS: Although the incidence of lung cancer among men in Denmark, Finland, Germany (Saarland), Italy (Varese), the Netherlands, Switzerland and the United Kingdom has been decreasing since the 1980s, the age-adjusted rate for men in other European countries increased at least until the 1990s. Among women the peak in incidence had not been reached in the 1990s. The proportion of adenocarcinoma has been increasing over time; the most likely explanation is the shift to low-tar filter cigarettes. In the 1990s more patients with localised non-small cell lung cancer received surgery than in the 1970s. Among patients with non-localised non-small cell lung cancer and among those with small cell lung cancer there was a trend towards more chemotherapy. There was fairly large variation in survival within Europe. Despite improvement in both the diagnosis and treatment, the overall prognosis for patients with non-small-cell lung cancer hardly improved over time. In contrast, the introduction and improvement of chemotherapy since the 1970s gave rise to an improvement in survival for patients with small-cell lung cancer. CONCLUSION: The epidemic of lung cancer is not over yet, especially in southern and eastern Europe. Prevention remains the best policy, but improvement in the management of lung cancer also remains very important.     

肺癌合并其他器官多原发癌的临床特点分析

背景和目的随着胸部计算机断层扫描(computed tomography, CT)肺癌早筛技术的普及,肺癌合并其他器官多原发癌(multiple primary malignancies, MPM)的检出比例不断提高。本研究就发病率、病理特征、诊疗特点和预后情况进行探讨分析,为完善此类疾病的临床诊疗提供研究依据。方法 2011年9月-2015年9月江苏省肿瘤医院胸外科共收治5,570例肺癌患者,回顾性分析其中61例肺癌合并其他器官MPM患者的临床病理特征。结果本研究中肺癌合并其他器官MPM的发病率为1.1%,其中同时多原发癌(synchronous MPM, SMPM)15例,异时多原发癌(metachronous MPM, MMPM)46例;结直肠癌、乳腺癌和甲状腺癌占肺癌合并其他器官MPM的前三位;患者总体5年生存率为39.3%,有71.4%的患者死于肺癌转移或复发,多因素分析发现肺癌患者的临床分期、肺癌与其他肿瘤发生的先后顺序、合并肿瘤的治疗状态以及是否存在表皮生长因子受体(epidermal growth factor receptor, EGFR)基因突变是影响患者生存期的重要因素。结论肺癌合并其他器官MPM的发病率并非罕见,相较于其他器官恶性肿瘤,肺癌是主要致死原因,中晚期肺癌、SMPM、肺癌先发、合并肿瘤仅获姑息治疗和无EGFR基因突变的患者预后较差。     

Trends in survival and excess risk of death after diagnosis of cancer in 1980-1996 in New South Wales, Australia

Survival from almost all cancers has improved during the last 30 years. There is debate over the reasons for the improvement. We examined trends in survival for 28 cancers from 1980 to 1996 in New South Wales (NSW), Australia, with adjustment for disease spread at diagnosis. NSW Central Cancer Registry data were used to estimate 5-year relative survival and relative excess risk of death for patients diagnosed in 1980-84, 1985-88, 1989-92 and 1993-96. Statistical significance of variation in excess deaths between periods of diagnosis was assessed using Poisson regression, with adjustment for age, sex, duration of follow-up, histology and spread of disease at diagnosis. There were statistically significant falls in excess deaths for 20 of the cancers with a 25% fall for all cancers combined. Cancers of the prostate, liver, thyroid, breast, gallbladder, body of uterus, rectum, cervix and ovary had falls of >30%. The falls varied by spread of disease; the largest being in localised and regionally spread tumours. Overall survival, when unadjusted for spread of cancer, generally fell in parallel with that in the specific categories of spread, which implies that stage migration did not contribute importantly to survival trends. While acknowledging the limitations of incomplete data on stage of cancer at diagnosis, we conclude that falls in excess deaths in NSW from 1980 to 1996 are unlikely, for many cancers, to be attributed to earlier diagnosis or stage migration; thus advances in cancer treatment have almost certainly contributed to them.     

Does marital status impact survival and quality of life in patients with non-small cell lung cancer? Observations from the mayo clinic lung cancer cohort

PURPOSE: Previous studies have found that marriage is associated with longer survival and better quality of life among lung cancer patients. The present study used the Mayo Clinic Lung Cancer Cohort to re-examine this issue. METHODS: In total, 5,898 non-small cell lung cancer (NSCLC) patients, who had available information on marital status and who had been enrolled in the Mayo Clinic Lung Cancer Cohort (MCLCC), were the focus of this study. Patients had extensive baseline and follow-up data on cancer stage, cancer treatment, and prognostic factors. All patients had been followed within the MCLCC with at least annual confirmation of vital status and patient-reported quality of life (the Lung Cancer Symptom Scale and the Linear Analogue Scales of Assessment). RESULTS: The numbers of patients who were married, single, divorced, and widowed at the time of cancer diagnosis were 4,457 (76%), 265 (4%), 440 (7%), and 736 (12%), respectively. No statistically significant difference in survival was observed among these four groups, even after adjusting for a variety of prognostic factors, such as age, gender, and tumor stage. However, exploratory analyses suggested that widowed and divorced patients received less aggressive cancer therapy, and certain patient subgroups, such as stage IA widowed patients, had a shorter survival. Divorced patients reported greater financial concerns, and married and widowed patients reported greater spirituality and better social support. CONCLUSION: This study did not observe differences in survival or quality of life based on marital status at the time of diagnosis of NSCLC, but subgroup analyses appear to suggest findings worthy of further exploration.     

以医院登记为基础的初诊未转移肺癌患者的转移部位分布及生存分析

背景与目的：通过分析以医院登记为基础的肺癌转移患者的转移部位分布和转移后生存状况,为肺癌患者的治疗和生存管理提供真实世界数据支持。方法：纳入2008—2017年于复旦大学附属肿瘤医院初诊未发生转移但在随访过程中发生转移的1 490例肺癌患者。通过患者复诊病史资料、电话随访及死因数据链接等方式收集生存随访信息。研究诊断时年龄、性别和组织学亚型对转移分布的影响。应用Kaplan-Meier法估计不同转移部位的转移后总生存（overall survival,OS）率。结果：中位随访时间为40.8个月,随访期间全死因死亡937例。67.7%的患者仅发生单部位转移,而32.3%的患者有多部位转移。常见的转移部位依次为骨（33.8%）、脑（33.6%）、肺（22.8%）、肝（12.0%）和肾上腺（3.7%）。女性患者更容易发生脑转移（37.8% vs 31.4%）,年轻患者更容易发生多部位转移,小细胞癌容易发生脑转移（47.2%）和肝转移（20.9%）。肺癌肺转移患者生存相对最好（1、3和5年OS率分别为78.3%、47.1%和29.5%）,肝转移患者生存相对最差（1、3和5年OS率分别为46.4%、15.2%和3.6%）。结论：肺癌转移患者骨、脑转移比例较高,转移部位分布与性别、诊断时年龄和组织学亚型相关,不同转移部位的预后具有差异性。未来可针对不同转移部位进行机制或临床治疗方案研究,以改善晚期肺癌患者的预后。     

Depression and functional status as predictors of death among cancer patients

BACKGROUND: The current study examined the extent to which depression and functional limitations contribute to the mortality of newly diagnosed cancer patients. The analysis focused on differences in survival times among cancer patients with new experiences of depressive symptoms and functional limitations and patients with a history of such limitations. METHODS: Data for the current analysis came from two panel studies conducted in Michigan between 1993 and 1997, including 871 adult (> or = 21 years of age) breast, colon, lung, and prostate carcinoma patients. Information came from four separate sources: the intake patient interview, a self-administered questionnaire, medical record audits, and the Death Certificate Registry of Michigan's Department of Community Health. With time to death as the primary outcome (followup of 571 days), data were analyzed using Kaplan-Meier product limit estimates and the Cox proportional hazard model. RESULTS: Cancer patients who, after diagnosis, report only new depressive symptoms or functional limitations, have the same survival chances as those who report none. Cancer patients with either previous emotional problems or previous physical limitations face, within the first 19 months after diagnosis, a 2.6 times greater hazard of dying than patients without prior problems. Patients with both previous emotional problems and physical limitations before diagnosis have a 7.6 times greater hazard of dying within that time frame. CONCLUSIONS: The current data show cancer patients with prior limitations and emotional problems have worse survival chances than would be expected on the basis of their cancer diagnosis alone. While depressive symptoms and functional limitations are common short-run responses to a cancer diagnosis and initial treatment, patients with no prior history of such problems appear to be more resilient.     

Prognosis of patients with ovarian cancer and borderline tumours diagnosed in Norway between 1954 and 1993

The Scandinavian countries exhibit some of the highest incidence rates of ovarian cancer in the world. Prognosis is poor, and the crude 5-year relative survival was 36% in the Nordic countries in the 1980s. Histology-specific prognostic trends in 5-year relative survival of patients with ovarian cancer and borderline tumours were examined, based on data from the population-based Cancer Registry of Norway. Relative risks (RRs) of dying were derived from Cox regression models. Logistic regression analysis on the proportion of cases with a localised tumour was performed. The 5-year relative survival rate of patients with ovarian cancer increased steadily from 1954 to 1993, being most pronounced in women below the age of 65 at the time of diagnosis. No improvement was seen for women older than 75. For all patients with ovarian cancer, an RR of dying of 0.48 (95% CI = 0.44–0.53) was estimated in 1989–1993 compared with 1954–1958. For patients with epithelial cancer, an RR of 0.63 (95% CI = 0.57–0.69) was seen in 1989–1993 compared with 1970–1973. Patients with mucinous, endometrioid and clear cell tumours had the highest odds of having a localised tumour. The age-adjusted 5-year relative survival rate of patients with borderline tumours was almost constant between 1970 and 1993, at about 93%. The prognosis of patients with ovarian cancer in Norway has improved since the 1950s. The very favourable prognosis of patients with borderline tumours has remained unchanged since the 1970s. Int. J. Cancer 75:663–670, 1998.© 1998 Wiley-Liss, Inc.     

结直肠癌肺转移和同时性肝转移生存分析

目的分析结直肠癌单纯性肺转移和结直肠癌肝转移(不包括肝、肺同时转移)患者的生存状况及影响因素。方法回顾性分析四川省肿瘤医院2011年11月至2018年6月收治的46例结直肠癌单纯性肺转移(其中同时性肺转移22例,异时性肺转移24例)和91例结直肠癌肝转移患者的临床资料、病理特征、治疗方法及预后生存情况,分析影响生存的相关因素,采用Cox回归模型分析影响单纯性结直肠癌肺／肝转移患者生存预后的相关因素。结果46例结直肠癌肺转移患者的总体中位生存时间为58(6～104)个月,5年生存率为478％;其中手术组的中位生存时间和5年生存率显著优于化疗组(P<001)。91例结直肠癌肝转移患者的总体中位生存时间为22(3～38)个月,3年生存率为333％,5年生存率为0％;其中手术组的中位生存时间和3年生存率显著优于其他组(P<001)。Cox回归分析结果显示肝转移灶非手术及非局部治疗是影响患者预后的独立危险因素。结论结直肠癌同时性肺转移患者的生存期低于异时性肺转移。对于严格挑选的结直肠癌同时性肝或肺转移患者积极手术治疗可能改善其生存率。     

Underutilization of radiotherapy for lung cancer in New South Wales,Australia

BACKGROUND:

Lung cancer is the leading cause of cancer death in most developed countries. Radiotherapy is important in its treatment, with an estimated optimal utilization rate between 45% and 68% at initial diagnosis. The objective of this study was to describe radiotherapy practice for lung cancer in New South Wales (NSW), Australia.

METHODS:

Patients with lung cancer were identified prospectively from the NSW Central Cancer Registry (CCR) from November 1, 2001 to December 31, 2002. Questionnaires were mailed to diagnosing and treating clinicians to obtain detailed information on diagnosis, staging, referrals, and treatment. The authors describe referral for and receipt of radiotherapy treatment.

RESULTS:

Of 1812 patients with lung cancer patients who were identified, 943 patients (52%) were referred for radiotherapy, 846 patients (47%) received a radiotherapy questionnaire, and 727 patients (40%) received radiotherapy. Compared with optimal radiotherapy, there was less curative radiotherapy to the primary site (20% actual vs 50% optimal), and there was more palliative radiotherapy to metastatic sites (36% actual vs 11% optimal). The greatest shortfall in radiotherapy use was observed in patients who had limited stage small cell lung cancer (46% actual vs 94% optimal). The use of combined‐modality treatment for stage III nonsmall cell lung cancer and for limited stage small cell lung cancer was uncommon.

CONCLUSIONS:

There is underutilization of radiotherapy for lung cancer in NSW, especially in small cell lung cancer. The use of combined‐modality treatment for potentially curable lung cancers is suboptimal. These issues have to be addressed to improve survival and quality of life for patients with lung cancer. Cancer 2010. © 2009 American Cancer Society.