无吸烟史肺癌与吸烟相关肺癌临床比较

目的:了解不同吸烟情况的肺癌患者的临床特征、治疗效果与生存的差别。方法:分析2005年—2015年十年中的3751例肺癌案例,对非吸烟者肺癌及吸烟者肺癌病例的临床资料进行探讨,在肺癌患者的年龄、性别、病例特点、治疗状况与近期成果与生存等来把其差异进行对比。结果:吸烟者肺癌比有67.8%,非吸烟者肺癌比例有32.2%。其中,男性患者80.3%、女性患者10.5%为吸烟者。不同病理类型中鳞癌的吸烟率最高,有83.7%,第二是小细胞肺癌78.1%。结论:吸烟与非吸烟者肺癌在临床特征与治疗方法中有着差别,但是生存情况没有差别。对于肺癌病理,按照患者的吸烟情况需要使用不同的治疗方式。     

无吸烟史肺癌临床特点分析

目的探讨有无吸烟史肺癌患者的临床特点与近期疗效的差异。方法比较非吸烟肺癌(137例)及吸烟肺癌(321例)患者年龄、性别、病理类型、分期、治疗情况和近期疗效等方面的差异。结果无吸烟史肺癌患者女性占57.7%,≤45岁患者占19.7%,进展期肺癌占78.0%,病理类型以腺癌为主(60.6%)。吸烟肺癌患者女性占3.7%,≤45岁患者占10.6%,进展期肺癌占73.2%,病理类型以鳞癌为主(53.6%),既往有慢性支气管炎、肺结核比例高,两组比较有统计学差异。但两组患者近期疗效相似。结论吸烟和非吸烟者肺癌的临床特点存在差异,近期疗效相似。     

2001-2008年1657例肺癌住院病例分析

目的 了解近年来肺癌住院病例的临床特征.方法 收集宁夏医科大学附属医院2001-2008年1657例新发肺癌住院患者的临床资料,分析性别、年龄、吸烟、病理类型等方面的特征及其动态变化.结果 女性肺癌的比例有所增加,所有病例男女性别比为2.67:1.00,其中前4年为3.10:1.00,后4年则下降为2.41:1.00;鳞癌、腺癌、小细胞癌男性均明显多于女性,鳞癌最为明显,小细胞癌次之,而腺癌男女比率差异不大,为1.16:1.00;40岁以上肺癌患者占绝大多数;8年来鳞癌病例数有所下降,而腺癌病例数明显增加.男性不同病理类型肺癌吸烟者比例有所不同.结论 近年来肺癌患者占总住院患者的比例无明显变化;鳞癌住院病例数仍居首位,但有所下降,腺癌住院病例明显上升;女性肺癌患者明显上升.肺癌的早期诊断仍存在很大困难,控制吸烟仍是今后肺癌防治的重点     

经支气管镜确诊肺癌患者病理类型与其基本临床特征的关系

目的探讨经支气管镜确诊肺癌患者组织学类型与性别、年龄、吸烟的关系.了解支气管镜诊断肺癌现状,为拓展运用支气管镜技术诊断呼吸系统恶性肿瘤奠定基础.方法选取225例经支气管镜检查且病理学明确诊断为肺癌患者的数据,进行统计学分析.结果经支气管镜确诊患者225例中,男性161例（71.6%）,女性64例（28.5%）;经支气管镜确诊病理类型包括鳞癌102例（45.3%）、腺癌58例（25.8%）、小细胞癌39例（17.3%）、其他类型肺癌26例（11.6%）;男性鳞癌最高占52.2%（P〈0.05）,男性鳞癌高于女性（P〈0.05）.50～69岁患者鳞癌比例最高,为57.8%（P〈0.01）;不吸烟患者腺癌比例最高占40.7%（P〈0.05）,吸烟者鳞癌比例最高达59.0%（P〈0.01）,特别是吸烟指数大于400的患者更高为60.2%（P〈0.01）.结论鳞癌是支气管镜诊断率最高的病理类型;其次为腺癌.男性以鳞癌为主,高于女性;50～69岁鳞癌多见;不吸烟患者腺癌多见,吸烟患者鳞癌多见.     

816例不同吸烟状况肺癌患者临床特点分析

目的探讨不同吸烟状况肺癌患者的临床特点、疗效和生存率。方法回顾性分析2007年2月~2010年2月在我院住院诊治的816例肺癌患者,比较两组肺癌病例在年龄、性别、病理类型、分期、近期疗效及生存率等方面的差异。结果两组比较,观察组患者按照性别计算发病率高于对照组,差异具有统计学意义(P<0.05),而年龄、居住地对于发病的影响不明显,差异无统计学意义(P>0.05)。同组间比较,观察组男性发病率高于女性,40岁以上发病率高于40岁以下,差异具有统计学意义(P<0.01)。对照组间40岁以上发病率高于40岁以下,差异具有统计学差异(P<0.01)。观察组病理类型中以鳞癌居多,病理分期多见Ⅲ期;对照组患者中则以小细胞肺癌常见,病理分期亦多见Ⅲ期。两组患者治疗后,观察组的有效率为60.95%,低于对照组的63.81%,差异无统计学意义(P>0.05)。观察组1年生存率低于对照组,差异具有统计学意义(P<0.05),而3年生存率则进一步降低,差异具有显著统计学意义(P<0.01)。结论中老年男性吸烟者是肺癌高发人群,多发鳞癌Ⅲ期,预后不佳,控制吸烟应是防治肺癌及提高生存率的有效措施。     

男性肺癌患者的临床特征分析

目的分析男性肺癌患者的临床特征,提高肺癌早期诊断。方法选择2004年11月至2006年11月住院的男性肺癌患者的病案资料,将其分为老年组及非老年组;吸烟组与非吸烟组,回顾性分析其临床特征。结果 803例男性肺癌中以鳞癌303例（37.73%）和腺癌248例（30.88%）最多见。全部患者的主要临床症状为咳嗽、咯血、气短和肺部感染。老年组中肺部感染和无症状者较非老年组多,吸烟组中咳嗽、咯血及远处转移者较非吸烟组多（P〈0.05）,差异有显著性。非小细胞癌就诊时非老年组较老年组多（P〈0.05）。获取病理最多的方式为气管镜,误诊例数最多的是鳞癌。结论肺癌的早期症状以咳嗽、咯血、气短和肺部感染最常见,需要仔细鉴别,对肺部炎症和经久不愈的咳嗽和咯血需要定期复查。     

女性非小细胞肺癌254例临床分析

目的通过分析女性非小细胞肺癌的特点,探讨影响女性非小细胞肺癌手术疗效的因素,提高对女性肺癌病例的诊断与治疗水平.方法对1988年至1993年期间1263例非小细胞肺癌病例全部资料的回顾性分析,其中女性254例,男性1009例.结果女性非小细胞肺癌的发病高峰期在50岁～59岁,仅有7.8%的女性病人有吸烟史,78%的病例术前肺功能检查正常,手术以肺叶切除为主,占80%,手术切除率95%,手术死亡1例,手术死亡率0.4%,术后并发症发生率9.8%,病理组织学类型腺癌159例(62.6%),鳞癌65例(25.6%),大细胞癌13例(5.1%),腺鳞混合癌17例(6.7%).术后5年生存率36%.结论女性非小细胞肺癌的发病高峰期在50岁～59岁,吸烟与女性肺癌的发病关系不密切,病理组织学类型以腺癌为主,术前分期评估有助于提高手术切除率,手术时淋巴结清扫程度和术前微转移病灶检测将影响术后生存率,提高女性非小细胞肺癌的手术疗效关键在于早期诊断,对于40岁以上或吸烟的女性及配偶吸烟之女性可行定期体检,及时发现,早期治疗.     

吸烟对表皮生长因子酪氨酸激酶抑制剂治疗晚期非小细胞肺癌疗效的影响研究

目的 探讨吸烟对表皮生长因子（EGFR）-酪氨酸激酶抑制剂（TKI）治疗晚期非小细胞肺癌（NSCLC）疗效的影响。方法 选取2012年1月-2014年1月天津医科大学总医院肿瘤科接受EGFR-TKI治疗的60例晚期NSCLC患者,给予厄洛替尼或吉非替尼治疗,根据不同吸烟状态分为吸烟组22例和非吸烟组38例。比较不同临床特征NSCLC患者吸烟率,两组临床疗效,Kaplan-Meier生存分析比较两组肿瘤进展时间（TTP）和总生存期（OS）。结果 不同性别NSCLC患者吸烟率比较,差异有统计学意义（P＜0.05）;不同年龄、组织学类型、TNM分期、功能状态（PS）评分、化疗类型NSCLC患者吸烟率比较,差异无统计学意义（P＞0.05）。吸烟组部分缓解1例、疾病稳定11例、疾病进展10例,非吸烟组分别为4例、27例、7例,两组临床疗效比较,差异有统计学意义（u=2.192,P=0.029）。吸烟组中位TTP为12个月,非吸烟组中位TTP为18个月,两组间差异有统计学意义（χ2=5.459,P=0.021）。吸烟组中位OS为 15个月,非吸烟组中位OS为 24个月,两组间差异无统计学意义（χ2=2.459,P=0.104）。结论 EGFR-TKI治疗晚期非吸烟NSCLC患者较吸烟患者更有效,且非吸烟患者无进展生存时间可能长于吸烟者。     

厄洛替尼治疗晚期非小细胞肺癌的疗效和生存因素分析

目的 分析厄洛替尼治疗晚期非小细胞肺癌 (NSCLC)的疗效、中位生存期、 疾病进展时间,同时分析与疗效和生存期可能相关的因素.方法 62例经病理或细胞学证实的Ⅲb～Ⅳ期NSCLC患者口服厄洛替尼 150 mg/d,直至出现严重不良反应或病灶进展,服药前及服药后每 4周进行肿瘤和全身评估.结果 病灶总缓解率4.8%,疾病控制率85.5%,1～2年生存率分别为59.68%、12.9%.中位生存期13.68个月,无疾病进展时间4个月.χ2检验显示性别、年龄、吸烟状况、有无手术、既往治疗种类数、病理类型、临床分期等在缓解率方面均无明显统计学差异.腺癌患者的中位生存期显著延长.经COX风险比例模型分析,肿瘤病理与既往有无手术为影响预后的主要因素.性别与吸烟状况在疗效、长期生存中未见差异.结论 厄洛替尼对本研究中治疗既往行化疗或靶向治疗失败的局部晚期和转移性非小细胞肺癌有较好近期疗效和生存益处.腺癌和含腺癌的混合亚型、既往曾行手术的患者可能是生存有益的标志.     

肺结核合并肺癌52例临床分析

目的：分析肺结核合并肺癌的临床特点、诊断方法、肺结核与肺癌之间的关系及提高诊断率的方法。方法选取52例肺结核合并肺癌患者,对其临床表现、病理类型、影像学特点、病灶部位、治疗方法及预后进行分析。结果肺结核合并肺癌患者中男性多于女性;有吸烟病史者42例（80.8%）,肺癌与肺结核位于同侧肺44例,同侧同叶40例（76.9%）,同侧肺但不同肺叶4例（7.7%）,不同侧肺8例（15.4%）。病理类型鳞癌23例（44.2%）、腺癌16例（30.8%）、腺鳞癌4例（7.4%）、小细胞肺癌6例（11.5%）、未定型癌3例（5.8%）。结论肺结核与肺癌常合并发生或伴发,使其症状表现复杂,症状体征明显加重,及时发现早期症状,积极完善相关的检查,及早确诊,积极治疗,提高治疗效果。     

Impact of smoking status and pathologic type on epidermal growth factor receptor mutations in lung cancer

Background  Epidermal growth factor receptor (EGFR) mutations in lung carcinomas can make the disease more responsive to the treatment with tyrosine kinase inhibitors. We aimed to evaluate the prevalence of EGFR mutations in a large series of lung carcinomas.

Methods  We examined 1195 consecutive lung cancer patients for EGFR mutations in exons 18, 19, and 21 using direct sequencing of polymerase chain reaction products. A detailed smoking history was obtained. Patients were categorized as never smokers (<100 lifetime cigarettes), former smokers (quit >1 year ago), or current smokers (quit <1 year ago).

Results  There were EGFR mutations in 9 (4.5%) of 201 squamous carcinomas, in 1 (2%) of 50 large cell carcinomas, and in 1 (2.3%) of 44 small cell carcinomas that were investigated. Three hundred and twenty-seven mutations were found in the series of 858 adenocarcinomas (38.1%). Among 858 lung adenocarcinomas, we detected EGFR mutations in 250 (48.6%) of 514 never smokers, 39 (33.9%) of 115 former smokers, and 38 (16.6%) of 229 current smokers. Significantly fewer EGFR mutations were found in people who smoked for more than 15 pack-years (P=0.0002) or stopped smoking less than 15 years ago (P=0.033) compared with individuals who never smoked.

Conclusions  Adenocarcinoma is the most frequent EGFR mutation pathologic type in lung cancer. The likelihood of EGFR mutations in exons 18, 19 and 21 decreases as the number of pack-years increases. Mutations were less common in people who smoked for more than 15 pack-years or who stopped smoking cigarettes less than 15 years ago. These data can assist clinicians in assessing the likelihood of exons 18, 19, or 21 EGFR mutations in Chinese patients with lung cancer when mutational analysis is not feasible.

     

胸段食道癌转移患者出现肺转移的危险因素分析

目的 通过分析胸段食道癌转移患者各种临床指标及肺转移的关系,探讨他们在胸段食道癌转移与肺转移的危险预测价值。方法 回顾性分析191例胸段食道癌癌转移患者性别、年龄、吸烟、饮酒、胸段食道癌大小、癌部位、癌病理类型等各种指标水平,二项logistic回归分析它们与胸段食道癌肺转移之间的关系。结果 191例胸段食道癌转移患者中肺部转移129例（67.54％）,吸烟病例为120例（62.83％）。胸段食道癌转移患者中吸烟、男性及胸部上、中段食道癌出现肺转移高于非肺转移病例（P=0.010, P=0.000及 P=0.020）。吸烟是胸段食道癌肺转移主要危险因素（P=0.004,回归系数1.037;OR值为2.821;OR值95%可信区间为1.399-5.689）。结论 胸段食道癌转移患者合并吸烟,其发生肺转移可能性显著增加。     

Deaths in Canada from lung cancer due to involuntary smoking.

Recently published evidence indicates that involuntary smoking causes an increased risk of lung cancer among nonsmokers. Information was compiled on the proportion of people who had never smoked among victims of lung cancer, the risk of lung cancer for nonsmokers married to smokers and the prevalence of such exposure. On the basis of these data we estimate that 50 to 60 of the deaths from lung cancer in Canada in 1985 among people who had never smoked were caused by spousal smoking; about 90% occurred in women. The total number of deaths from lung cancer attributable to exposure to tobacco smoke from spouses and other sources (mainly the workplace) was derived by applying estimated age- and sex-specific rates of death from lung cancer attributable to such exposure to the population of Canadians who have never smoked; about 330 deaths from lung cancer annually are attributable to such exposure.     

The effect of cessation of smoking on the accumulative survival rates of patients with symptomatic peripheral vascular disease

A study of the accumulative survival rates of 133 patients with symptomatic peripheral vascular disease was carried out comparing the survival rates of tobacco smokers and non-smokers. Within the smoking group, those who continued to smoke after the surgery were compared to those who ceased smoking. Of these patients with peripheral vascular disease, 86% were, or had been, smokers. Their survival rates were less than for those who had never been smokers. Of the smoking group, those who claimed to have ceased smoking had almost twice the chance of surviving five years than those who continued to smoke. From these data, we conclude that it is never too late to stop the smoking habit.     

Smoking and death rates: report on forty-four months of follow-up of 187,783 men. 2. Death rates by cause

Information was gathered on the smoking habits of 187,783 white men between the ages of 50 and 69 between January 1 and May 31, 1952. The men were subsequently traced through October 31, 1955. 11,870 men died during this period. The total experience covered 667,753 man years. For microscopically proved cases of cancer and for the total cases reported as cancer it was found that the death rates were higher among regular cigarette smokers than among men who never smoked, that the mortality ratio increased with the number of cigarettes smoked each day, and that the death rates were higher among pipe and cigar smokers than among men who never smoked. 7316 deaths occurred among regular cigarette smokers; this was an excess of 2665 over the 4651 deaths that would have occurred had the age-specific death rates for smokers been equal to that for nonsmokers. Coronary disease accounted for 52.1% of the excess; lung cancer accounted for 13.5% of the excess; and cancer of other sites accounted for 13.5% of the excess. An extremely high association between cigarette smoking and death rates for men with lung cancer was found in both rural areas and large cities. Only 338 deaths were ascribed to pulmonary diseases other than lung cancer. Only 1120 (9.4%) of the 11,870 deaths were attributed to diseases other than cancer, cardiac, circulatory, and pulmonary diseases and accidents, violence, and suicide. Only 3 of the specific disease entities - gastric and duodenal ulcers and cirrhosis of the liver - showed a statistically significant degree of association with smoking habits. The most important finding of this study was the high degree of association between cigarette smoking and the total death rate.     

肺癌患者吸烟与p53基因突变关联性的Meta分析

目的：采用Meta分析的方法综合评价肺癌患者吸烟与p53基因突变的关联性。 方法：全面检索PubMed、Web of Science、ProQuest和Medline数据库,收集有关肺癌患者吸烟与p53基因突变关系研究的文献。在全面文献回顾的基础上对文献进行筛选、评价和数据提取。采用Stata 12.0软件对纳入文献进行Meta分析,包括异质性检验、评估文献发表偏倚、敏感性分析、合并效应量及累积Meta分析。 结果：本研究共纳入15篇文献,包含1 770
名肺癌患者,其中69.6%为吸烟者,30.4%为非吸烟者。异质性检验未发现各研究间存在明显异质性。肺癌患者吸烟与p53基因突变关系的合并OR=2.70,95%CI=2.04~3.59。 结论：肺癌患者吸烟与p53基因突变有关联性;与非吸烟者比较,吸烟者的p53基因突变风险高。
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非吸烟与吸烟肺癌患者的围手术期指标比较研究

目的：研究非吸烟肺癌患者与吸烟肺癌患者在手术前后相关临床指标的区别。方法回顾性分析2012年1月至2015年10月某院胸外科手术治疗的肺癌患者411例,均经病理学证实。其中非吸烟者（非吸烟组）123例,男49例,女74例,平均年龄63.6岁;吸烟者（吸烟组）216例,男174例,女42例,平均年龄60.6岁;另72例吸烟后又戒烟患者不在研究范围内。比较分析两组患者围手术期相关临床指标的区别,包括肺功能、淋巴结转移率、组织分化程度、术后肺部感染发生率、引流液大于150 m L的天数、术后住院天数等。结果全组患者均无围手术期死亡及严重并发症。非吸烟组与吸烟组比较,在肺功能方面前者明显优于后者;淋巴结转移率前者略高,但差异无统计学意义;组织分化程度上前者高分化型比例高于后者,而低分化型比例明显低于后者,差异均有统计学意义。非吸烟组患者术后肺部感染发生率低于吸烟组,引流液大于150mL天数前者少于后者,术后住院天数前者少于后者,差异均有统计学意义。结论非吸烟肺癌患者较吸烟肺癌患者,肺功能更好,组织分化程度更高,术后肺部感染发生几率更低,恢复更快。     

利用组织微阵列技术研究MMP-12在肺癌中的表达及意义

目的研究MMPl2在人非小细胞肺癌组织中的表达及临床意义。方法应用组织微阵列技术结合免疫组化方法检测120例手术后非小细胞肺癌标本中MMPl2的表达状况，并分析其临床病理意义及与预后的关系。结果120例肺癌中MMPl2表达阳性率为70％。MMPl2表达在患者不同性别、年龄（≥50岁或〈50岁）、肿瘤大小（≥3cm或〈3cm）、临床分期（Ⅰ、Ⅱ期或Ⅲ、Ⅳ期）中差异无统计学意义（P〉0．05）。伴淋巴结转移者MMPl2阳性表达率（90．4％）高于不伴淋巴结转移者（58．9％），肺鳞癌中MMPl2阳性表达率（87．8％）高于腺癌组（31．5％），吸烟者MMPl2阳性表达率（86．8％）高于不吸烟者（40．9％），MMPl2阳性表达患者生存率低于MMPl2阴性表达者；差异均有统计学意义（P〈0．05）。结论非小细胞肺癌中MMPl2表达与患者性别、年龄、肿瘤大小及肿瘤TNM分期无关；MMPl2与肺鳞癌及吸烟关系密切；与淋巴结转移及生存期密切相关：MMPl2阳性表达者生存率低、预后差。     

Comparisons of multiple characteristics between young and old lung cancer patients

Background  Risk factors that contribute to younger patients with lung cancer are still relatively unknown. The aim of this study was to compare the clinical characteristics, histological types, stages at diagnosis, treatment modalities and survival rates between young and old patients with lung cancer.

Methods  The study was designed as a retrospective review of all lung cancer patients admitted to the Third Affiliated Hospital of Harbin Medical University from 1998 to 2008. Survival analyses using univariate and multivariate approaches were performed to compare the survival rates between different age groups and to discover potential prognostic factors.

Results  This research included 3320 patients with primary lung cancer, of whom 626 (18.8%) were 45 years old or younger at the time of diagnosis. The percentage of smokers and the male to female ratios between the young and old patient groups were 51.27% vs. 70.6% (P <0.001) and 1.99 vs. 2.13 (P＝0.4801), respectively. The young patient group had a higher incidence of adenocarcinoma and fewer surgeries. The 1-year, 3-year and 5-year survival rates in the young patient group were generally lower than those of the old patient group, with significant differences (P＝0.0232). The clinical stage of the tumor was a prognostic factor for both non-small cell lung cancer patients (P <0.0001) and small cell lung cancer patients (P=0.0002). Symptoms, diagnostic method, histology, smoking, treatment modality and body mass index were shown to have significant relationships with the survival of lung cancer patients (P <0.05).

Conclusions  Patients with lung cancer who are younger than 45 years old might have a significantly poorer prognosis than that of older patients. Symptoms, diagnosis method, histology, smoking, treatment modality and body mass index can be independent prognostic factors for lung cancer.