Study On The Epidemiology Characteristics And Prognosis Of Hospitalized Lung Cancer Patients

OBJECTIVE:To describe the clinical characteristics of patients with lung cancer and survival.METHODS:To study the characteristics, risk factors and prognosis of local patients with lung cancer treated in Shanghai Chest Hospital during 2000 to 2008 by using cases data extracting combined with following-up study. We use Excel to set a data base, SPSS 16.0 to do the statistical analysis, Kaplan Meier method to calculate survival rate and compared among different clinical features, Cos regression model was used to analyse the prognostic factors of lung cancer.RESULTS:7323 Shanghai patients were firstly diagnosed lung cancer in Shanghai Chest Hospital during 2000 to 2008. Among these cases,2482 patients are still alive,109 cases were lost, and 216 case with missing history. There were more cases of male lung cancer than that of female. An increasing tendency of the number of the cases in both male and female during the 9 years. The patients average age was 61.8±10.3 years old. Diagnosed for the first time concentrated in the age distribution of 40 to 79 years to a maximum of 60 to 69 years.80.4% of male lung cancer patients with history of smoking, which was significantly higher than women. Male patients with previous lung disease history was higher than female, male patients mostly with chronic bronchitis while female mostly with pulmonary tuberculosis. Female patients' previous history of tumor is more common than in male. Disease lesion was more common in right site than left. Central type lung cancer was common in male while peripheral type was common in female. Bone metastases is the commonest metastatic site in both man and women.90% of lung cancer cases diagnosed based on histological exam. Pathological type, the rate of adenocarcinoma was 48.1%, up to 74.0% female patients with adenocarcinoma. Most patients with lung cancer was stageⅢandⅣ. Up to 29.3% patient was stageⅣ, while 52.3% patients received surgeries.Survival analysis showed that the lung cancer patients' survival rate for 1,3,5 and 8 years was 64.7%,34.9%,26.7% and 20.9%, respectively. Among them, male patients'survival rate for 1,3,5 and 8 years was 60.8%,31.6%,23.9% and 17.2%, respectively, and that of female patients was 73.6%,42.6%,33.2% and 27.3%, respectively. The survival rates between men and women were statistically different at all time nodes. The age group 50 to 59 years old had the longest median survival time. 1-year survival rate was highest in age group 40 to 49 years old.3 and 5-year survival rate was the highest in the age group under 40 years old.40 to 49 age group was the highest of 8-year survival rate, but there was no significant difference in the survival rates of all the age groups (P<0.05). Among the pathological types, adenocarcinoma had the highest survival rate. The 1,3,5,8-year survival rate were 71.0%,41.4%, 31.7% and 25.4%, respectively. Small cell lung cancer was the lowest in survival rate, which were 48.4%,12.5%,10.7% and 9.6%, Survival rate of squamous cell carcinoma were 65.2%,36.7%,29.3% and 22.7%, respectively. Survival rate of adeno-squamous carcinoma were 69.5%,35.5%,24.4% and 19.8%, respectively. Patients pathological types have a significant effect on survival rate. Observing the survival time of lung cancer among different stage, the 5-year survival rates of stage la, stageⅠb, stageⅡa, stageⅡb, stageⅡa, stageⅢb and stageⅣwere 75.3%,63.6%, 59.6%,37.3%,20.4%,10.5% and 5.3%, respectively. The difference of tumor stage on the survival rates was statistically significant (P<0.05). The tumor size (T1, T2, T3, T4) and the level of the surrounding invasions effect on the 1,3,5,8-year survival rate significantly. The T stage effect on the survival had statistically differences (P< 0.05). Lymph node metastasis, also called N stage was also statistically significant impact on survival (P<0.05). Systemic metastasis (M0, M1) had considerable impact on the survival rate, and was statistically significant. The impact of different treatment methods on the survival rate was considerable. Surgery and postoperative chemotherapy had the highest survival rate. The 1,3,5,8-year survival rate was 89.4%,65.1%,50.1% and 41.6%, respectively. Radiotherapy alone had the lowest survival rates, which was 37.3%,10.4%,4.7% and 4.7%. We found that different surgical methods impacted the survival rate of lung cancer patients.1,3,5,8-year survival rate of patients received lobectomy was the highest, which was 86.7%,62.5%, 50.9% and 41.2%, respectively. Survival rate of patients had wedge resection was 81.4%,48.7%,34.6% and 18.6%, respectively. Survival rate of patients had Entire pneumonectomy was the lowest, which was 66.4%,33.8%,25.1% and 20.5% respectively.Cox multivariate analysis discovered that gender, pathological type, tumor size, lymph node metastasis, systemic metastasis, the first symptom or sign, smoking, tumor stage and treatment were the independent factors of the prognosis of patients with lung cancer.CONCLUSION:The clinical features, histological types, treatment and prognosis are different between male and female lung cancer patients. The best treatment for lung cancer is surgery while active multidisciplinary treatment such as postoperative adjuvant therapy can consolidate the surgery. There is a need to enhance people's awareness of periodic medical examinations. The feasibility of the high-risk of lung cancer patients' periodic medical examinations should be improved for the case of early diagnosis and the detection rate of pathology. We should use the treatment right to improve the prognosis of patients with lung cancer.