肺鳞癌与腺癌非手术治疗预后差异的原因分析

目的分析非手术治疗的肺鳞癌与腺癌预后差异的原因。方法１９９０年１２月～１９９４年１２月间以根治性放疗为主的非手术治疗１７７例肺癌（鳞癌１２５例，腺癌５２例），采用Ｋａｐｌａｎ－Ｍｅｔｅｒ计算方法和Ｃｏｘ多因素分析方法分析鳞癌和腺癌的生存率、肿瘤局部控制率、无远处转移率，并进行比较。结果１年和２年生存率，肺鳞癌为８０．３％和４４％，显著高于腺癌的５５．４％和１７．２％（Ｐ＜０．００１）；１年和２年局部控制率，肺鳞癌为７９．５％和４３．４％，肺腺癌为５４．３％和２７．６％（Ｐ＝０．００７）；１年和２年无远处转移率，肺鳞癌为８６％和７３．９％，腺癌为６２．８％和２２．９％（Ｐ＜０．００１）。Ｃｏｘ多因素分析结果表明组织学类型在生存率、局部控制率、无远处转移率三项指标中均有显著差异（产均＜０．０１）。结论在非手术治疗中，肺鳞癌较腺癌患者预后好；预后差异的原因在于鳞癌局部控制率高而远处转移率低。

DISCUSSION OF PROGNOSTIC FACTORS IN SQUAMOUS CELL CARCINOMA AND ADENOCARCINOMA OF LUNG TREATED NON-SURGICALLY

To analyse possible differences in the prognosis and their causes between squamous celllung carcinoma and lung adenocarcinoma.METHODS From Dec. 1990 to Dec. 1994, 177 patients with squamous cell lung carcinoma and adenocarcinoma received radical radiotherapy were entered into this study. There were 125 squamous cell carclnoma patients and 52 adenocarcinoma patients. 159 cases were male, and 18 cases female. Median age was 58years.RESULTS The 1,2 year survival rates for squamous cell carcinoma were 80. 3% and 44% respectively. The 1,2 year local control rates of squamous cell carcinoma (79. 5 %,43. 4% )were better than those ofadenocarcinoma(54. 3% and 27. 6% ) (P = 0. 007). The 1, 2 year distant metastasis free survival rates ofsquamous cell carcinoma (86 %, 73. 9 % ) were better than those of adenocarcinoma (62. 8%, 22. 9% ) (P<0. 001). Cox regression model multivariate analysis survival showed significant differences between survival,local control survival and distant metastasis free survival rated (P<0. 001 ).CONCLUSIONS In non-surgically treated cases,squamous cell lung carcinoma had a better prognosisthan adenocarcinoma. The reasons for this difference in prognosis are due to the fact there is better localcontrol of squamous cell carcinomas as well as lower incidence of distant metastasis.