Analysis Of Prognostic Factors In 168 Cases Of Lung Adenocarcinoma Patients

Objectives:Currently, lung cancer is internationally recognized as the most common malignant tumors, due to its poor prognosis, high mortality rate, short survival time and the consequent serious damages. In recent years there was a rising trend of the incidence rate of lung adenocarcinom. As a main pathologic type of lung cancer, lung adenocarcinoma typically features small peripheral lesions and is not easy to be discovered. Also, regional lymph node and distant metastasis are easily found in the patients of this disease, so 5 years survival rate is low. But with research progress and diverse treatments as well as the advent of the targeted drugs in recent years, lung adenocarcinoma patients’ survival has been significantly prolonged. Meanwhile, significant differences exist among the individuals. Therefore, analysis of the factors that affect the prognosis of lung adenocarcinoma is particularly important. As we all know, there are a large number of factors that affect the prognosis of tumor. From the analysis of the lung adenocarcinoma patients it is found that significant differences exist among the patients in their personal factors, the situation of their tumor and the treatment they have received. These are mainly reflected in their age at diagnosis, gender, whether they smoke or not and the number of cigarettes they smoke, tumor stage and the degree of tumor cell differentiation, the presence of organ metastases and specific metastatic sites, the presence of multiple organ metastasis, whether they have undergone surgical treatment, whether they accept chemotherapy and the cycles of chemotherapy, whether they accept radiotherapy, whether they have received targeted therapy and what specific targeted drugs they used. This thesis mainly discuss how the above-mentioned factors have influence on lung adenocarcinoma prognosis, aiming to find out the influential clinical factors in the prognosis of lung adenocarcinoma in order to provide a theoretical basis to carry out individualized treatment and prolong the survival time of the patients. Methods:Patients who first received treatment from January 2010 to December 2012 in the first hospital of Qinhuangdao and diagnosed through pathological science examination with lung adenocarcinoma were enrolled. These patients do not have other serious underlying diseases and have never received any anti-tumor therapy. We collected a total of 168 cases of lung adenocarcinoma patients and recorded their age, gender, smoking status, malignant tumor family history, tumor staging and degree of differentiation, the condition of organ metastasis, and specific treatment programs among other information in detail. We also followed up all the patients until December 31, 2015 by telephone and recorded their total survival as the prognostic indicator. Statistical data are analyzed by SPSS17.0. Kaplan-Meier survival analysis and Log-rank test analysis are applied to compare the influences of clinical features on the prognosis. Cox regression model is used for multivariate analysis to identify independent factors of prognosis in patients with lung adenocarcinoma. The difference value of P < 0.05 is considered statistically significant. Result:Upon the follow-up of 168 patients with lung adenocarcinoma, as of December 31, 2015, the follow-up of 9 patients were lost, thus follow-up rate was 94.6%. 11 cases survived and 148 cases died from lung cancer. The analysis of prognosis in the 168 cases of lung adenocarcinoma patients showed that the total survival period was 0.5 to 68.2 months, median survival time 14.2 months, 1 year survival rate 60.2%, 2 year survival rate 34.1% and 3 year survival rate 20.2%.A comprehensive analysis is performed of clinical features in the 168 cases of lung adenocarcinoma patients and the effects on the their prognosis. It is found through single factor analysis that all the following factors have effect on the prognosis of lung adenocarcinoma patients. They are: tumor stage, degree of tumor cell differentiation, whether organ like brain, bone or liver metastasis had occurred when diagnosed, whether there is metastasis of multiple organ, whether they have received surgical treatment or chemotherapy, the number of chemotherapy cycles, and whether targeted treatment has been applied to them(P value < 0.05). In contrast, little effects can be found in factors such as patient’s age when diagnosed, gender, whether they smoke or not, the number of cigarettes they smoke, family history of malignant tumor, experience of radiotherapy(P value > 0.05).Targeted treatment has improved the prognosis in patients with lung adenocarcinoma. In this study, a total of 69 cases of lung adenocarcinoma patients accepted target therapy and their median survival time was 21.6 months. The target therapeutic drugs applied to them mainly falls into two categories, namely tyrosine kinase inhibitors(TKI) and anti-tumor-angiogenesis(McAb) drugs. 48 of the patients took oral TKI drugs, with median survival time 19.6 months; 14 patients took anti-tumor-angiogenesis drugs, with median survival time 32.2 months; 7 patients took both of the drugs, with median survival time 21.6 months. But statistical analyses indicated that there is no significant difference between the median survival time in the above three instances.(P = 0.23). In terms of the selection of treatment scheme, 6 patients received targeted treatment alone, with median survival time 13.5 months; 23 patients received both targeted treatment and chemotherapy, with median survival time 24.2 months; 9 patients received both targeted treatment and radiotherapy, with median survival time 12.7 months; 31 patients received the combination of targeted treatment, radiotherapy and chemotherapy, with median survival time 30.6 months. Statistical analysis showed that difference exists in the median survival time among above three groups(P=0.020), which indicates that median survival time is the longest when the combination of targeted treatment, radiotherapy and chemotherapy is applied. When the aforementioned 9 factors that affect the prognosis of lung adenocarcinoma in the single factor analysis is put into Cox proportional hazard model, the results showed that the following 8 clinical features are the independent factors that have effect on prognosis of lung adenocarcinoma. They are: tumor stage, degree of tumor cell differentiation, the presence of brain, bone or liver metastasis when diagnosed, whether the patient has received surgical treatment or chemotherapy, the number of chemotherapy cycles and whether targeted treatment is applied(P value < 0.05). Conclusion:1. The prognosis of patients with lung adenocarcinoma is affected by the tumor and treatment.2.Tumor stage, degree of tumor cell differentiation, brain metastasis, bone metastasis, liver metastasis, surgery, chemotherapy and targeted therapy are all independent prognostic factors in patients with lung adenocarcinoma.3. Targeted therapy helps to improve the prognosis in patients with lung adenocarcinoma. The combination of targeted therapy, chemotherapy and radiotherapy can prolong the survival time for patients with lung adenocarcinoma.