Study On Clinical Pathological Characteristics And Prognostic Factors Of Lung Cancer In Young Patients

Objective：Analysis young patients under40years old of lung cancer of theclinical pathological features, to explore the related prognostic factors of lung cancer inyoung patients, through the study to provide theoretical basis for early detection, earlydiagnosis, early treatment of youth lung cancer.Methods：1.Collection2007-2012for treatment in the First Affiliated Hospital of DalianMedical University,104cases of age≦40youth lung cancer, men48cases, women56cases. Age22to40years old, the median age is38±3.75years old.2.Collect patients’ gender, age, initial symptoms, family history, smoking status,loss of weight, ECOG；diagnosis time, misdiagnosis; imaging characteristics，distantmetastasis; pathological type of lung cancer, tumor differentiation of youth lung cancer,TNM stage of tumor; way of treatment, the level of CEA、CYFRA21-1confirmed at thefirst time.3.SPSS19.0statistical software was used in this study，use the methods ofcomposition to describe the clinical characteristics of youth lung cancer, single factoranalysis and median survival times were estimated by using the method ofKaplan—Meier；Cox proportional regression was used to multy factors analysis。Results:1. Clinical featuresWomen（53.85%） has higher disease ratio than Men48(46.15%), the ratio of menand women is1:1.17, the median age is38±3.75years old.36-40years old take thebiggest part（69.23%）, the ratio of lung cancer is increasing from22to40years old.The initial symptom was cough (40.38%), second is chest pain, blood in phlegm.Theaverage symptoms last time is5.10months, the part of4≤T＜8is higher. The misdiagnosis rate was22.12%.Misdiagnosis are mainly composed of pneumoniaand phthisis.ECOG0-1is101cases（97.12%）,ECOG2is3cases（2.89%）.Smokers are28cases(26.92%), mainly man patients（25.96%）; Men have highsmoking ratio in each pathological type.CT manifestations around70cases (64.42%), center type34cases (32.69%). Leftlower lung is23cases (22.12%), upper right lung is21cases (20.19%), Which theproportion is larger.Youth lung cancer diagnosed as has happened in distant metastasis,39cases(37.50%), and a larger percentage of bone metastases （38.46%）, followed by spread tothe liver(20.51%) and brain metastases(15.38%).2. Pathological features，TNM and serum tumour markerPathologic type is priority of adenocarcinoma (63.46%), followed by small cell lungcancer (14.42%). Female patients with adenocarcinoma (62.12%) is significantly higherthan male.Young people the differentiation of lung cancer is given priority to withundifferentiated and low differentiation (53.85%).Stage Ⅲ and Ⅳ accounted for69.23%. serum CEA p5ng/ml and serumCYFRA21-1or greater proportion of3.3ng/ml>50%in Stage Ⅲ and Ⅳ.3. Way of treatmentSurgical resection rate was38cases,36.54%in treatment,32cases (30.78%)chemotherapy combined with radiotherapy, chemotherapy alone,34cases (32.69%).4. Survival conditions and prognostic factorsYouth lung cancer the MST15.66months,1year survival rate of youth lung cancerwas53.8%,3year survival rate of youth lung cancer was7.69%.Kaplan-Meier analysis showed that weight loss, ECOG score, degree ofdifferentiation, distant metastasis, treatment, serum CEA level and the level of serumCYFRA21-1is associated with youth to the prognosis of lung cancer (P <0.05). Sex,smoking history, family history, pathological type, clinical stage has nothing to do withthe youth to the prognosis of lung cancer (P>0.05). ECOG score0-1MST (18.3months) from ECOG2points significantly longer (6.50months); Weight loss is theMST (13.8months) less weight no change short (21.3months); Distant metastasis is the shorter of the MST no distant metastasis; Undifferentiated lung cancer the MST12.0months in the differentiation of the MST shortest; Treatment of surgery pluschemotherapy longest MST (26.6months); Serum CEA (12.5months) and serumCYFRA21-1(12.0months) increased levels of the MST is short.COX regression analysis showed ECOG, degree of differentiation，distant metastasis,treatment, level of blood CEA, level of blood CYFRA21-1are the independent factorsof prognosis of youth lung cancer (P＜0.05).Conclusion:1.Youth lung cancer mostly intial with cough, duration of symptoms is long,misdiagnosis rate is high;2. Adenocarcinoma is the most Pathological type in youth lung cancer. women havehigh prevalence, the proportion of undifferentiated and low differentiation is high, theproportion of distant metastasis is high, and stage is mainly stageⅢ and Ⅳ when itwas confirmed, poor prognosis.3. Youth lung caner should be early detection,mainly surgery treatment, improve thesurvival rate.4. ECOG, way of treatment, degree of lung cancer of differentiation, level of serumCEA, level of serum C211, distant metastasis are the independent factors to influencethe prognosis of youth lung cancer.