| Objective: Explored a variety of factors about postopertative prognosis of non-small cell lung cancer(NSCLC), to study the influence of how to improve the rate of long-term survival of postoperative patients with non-small cell lung cancer.Methods: Selected 200 patients with non-small cell lung cancer in a single treatment group from April 2008 to September 2013 in the Thoracic Surgery of Eastern Hospital of the Fourth Hospital of Hebei Medical University. A retrospective clinical analysis with the data about these 200 patients was carried out. To achieve survival information and survival time in months about every patient by medical history information, telephone and outpatient followed up patients, excluded the patients who didn’t die from lung cancer. Selected some indexes from followed up data and clinical data to study: included age, sex, smoking history, histological type, surgical approach, thoracotomy approach, pathological stage, whether did chemotherapy treatment after surgery, postoperative KPS and weight change after surgery. The results were observed quantization assignment, wherein the TNM stage of lung cancer reclassified by the seventh edition which was adopted according to the international standards of the US Joint Committee on Cancer(AJCC) and the International Union Against Cancer(UICC) Amendment. Used the package SPSS19.0 to analysis 200 patients with multi-factors comparison from different clinical characteristics, survival curves were estimated according to the Kaplan-Meier method(product-limit method), univariate significant test in accordance with the Log-rank method(log-rank test), multivariate survival analysis in accordance with COX proportional hazards model analysis review.Results: 200 cases of non-small cell lung cancer patients in one group whose 1-year survival rate was 90.0%, 3-year survival rate was 65.7%, 5-year survival rate was 38.0%.1 All univariate analysis showed:(1) In different gender groups, 142 male patients whose 3-year survival rate was 59.4 %; 58 female patients whose 3-year survival rate was 80.6%. The difference in different gender was significant in statistically(P=0.001).(2) In different groups about patients whether had a smoking history, 130 patients had a smoking history whose 3-year survival rate was 59.0% and 70 patients had no smoking history whose 3-year survival rate was 77.9%. The difference between them was significant in statistically(P=0.018).(3) In the groups with different pathological types, 80 patients with adenocarcinoma whose 3-year survival rate was 59.4%; 104 patients with squamous cell carcinoma whose 3-year survival rate was 72.4%; 8 patients with adenosquamous carcinoma whose 3-year survival rate was 58.3%; 8 patients with other types whose 3-year survival rate was 50.0%. The difference between them was no significant in statistically(P=0.497).(4) In the groups with different TNM stage, the number of patients in stage I was 93 whose 3-year survival rate was 83.2%, the number of patients in stage Ⅱ was 51 whose 3-year survival rate was 54.3%, the number of patients in stage Ⅲ was 49 whose 3-year survival rate was 45.0%, the number of patients in stage Ⅳ was 7 whose 3-year survival rate was 42.9%. The difference between them was significant in statistically(P<0.001).(5) In the groups with different ways of operation, the number of patients of simple lobectomy was 143 whose 3-year survival rate was 72.9%, the number of patients of combined lobectomy was 20 whose 3-year survival rate was 37.5%, the number of patients of sleeve resection was 11 whose 3-year survival rate was 36.4%, the number of patients of lung resection was 20 whose 3-year survival rate was 47.6%, the number of patients of wedge resection was 6 cases whose 3-year survival rate was 62.5%. There was a significant difference between them in statistically(P=0.012).(6) In the different groups about whether did chemotherapy after surgery, the number of patients with postoperative chemotherapy was 69 whose 3-year survival rate was 81.8%, the number of patients with no postoperative chemotherapy was 131 whose 3-year survival rate was 56.8%.The difference between them was significant in statistically(P=0.001).(7) In the groups with different postoperative functional status(KPS score), the number of patients of equal or greater than 90 points was 100 whose 3-year survival rate was 91.6%, the number of patients of 80-60 points was 82 whose 3-year survival rate was 47.7%, the number of patients of 50-30 points was 18 whose 3-year survival rate was 17.8%. The difference between them was significant in statistically(P <0.001).(8) In the groups with different weight changes, the number of patients with weight gain was 61 whose 3-year survival rate was 93.3%, the number of patients with weight loss was 38 whose 3-year survival rate of 18.9%, the number of patients with no change was 101 whose 3-year survival rate was 65.7%. The difference between them was significant in statistically(P<0.001).2 The TNM stage was the stratified standard and further analyze the differences of every factor in stage I, II, and III. The results showed:(1) In different gender groups, 62 male patients in stage I whose 3-year survival rate was 74.9%, 5 female patients in stage Ⅰ whose 3-year survival rate was 80%; 42 male patients in stage II whose 3-year survival rate was 51.4%, 9 female patients in stage II whose 3-year survival rate was 62.2%; 32 male patients in stage Ⅲ whose 3-year survival rate was 40.0%, 17 female patients in stage Ⅲ whose 3-year survival rate was 64.2% The difference in different gender in stage Ⅰ and stage Ⅲ was significant in statistically(P=0.006 and P=0.049, respectively).(2) In different groups about the patients whether had a smoking history, 58 patients had a smoking history in stage Ⅰ whose 3-year survival rate was 85.7%, 35 patients had no smoking history in stage I whose 3-year survival rate was 85.7%; 38 patients had a smoking history in stage II whose 3-year survival rate was 48.3%, 13 patients had no smoking history in stage II whose 3-year survival rate was 53.8%; 29 patients had a smoking history in stage Ⅲ whose 3-year survival rate was27.4%, 20 patients had no smoking history in stage Ⅲ whose 3-year survival rate was 53.8%. The difference between them in stage III was significant in statistically(P=0.022).(3) In the groups with different pathological types(because the cases of other types was too little, there only discussed the adenocarcinoma and squamous cell carcinoma), 32 adenocarcinoma patients in stage Ⅰ whose 3-year survival rate was 73.2%, 56 squamous cell carcinoma patients in stage I whose 3-year survival rate was 86.1%; 29 adenocarcinoma patients in stage Ⅱ whose 3-year survival rate was 52.2%, 15 squamous cell carcinoma patients in stage Ⅱ whose 3-year survival rate was 56.6%; 18 adenocarcinoma patients in stage Ⅲ whose 3-year survival rate was 31.7%, 27 squamous cell carcinoma patients in stage Ⅲ whose 3-year survival rate was 57.0%. The difference in different pathological types in stage Ⅲ was significant in statistically(P=0.033).(4) In the groups with different ways of operation, the number of patients of simple lobectomy in stage I was 77 whose 3-year survival rate was 90.1%, the number of patients of combined lobectomy in stage I was 4 whose 3-year survival rate was 37.5%, the number of patients of sleeve resection in stage Ⅰ was 2 whose 3-year survival rate was-, the number of patients of lung resection in stage I was 6 whose 3-year survival rate was 50.0%, the number of patients of wedge resection in stage I was 4 whose 3-year survival rate was75.0%; the number of patients of simple lobectomy in stage Ⅱ was 36 whose 3-year survival rate was 56.8%, the number of patients of combined lobectomy in stage II was 5 whose 3-year survival rate was 30.0%, the number of patients of sleeve resection in stage II was 3 whose 3-year survival rate was 66.7%, the number of patients of lung resection in stage Ⅱ was 7 whose 3-year survival rate was 57.1%; the number of patients of simple lobectomy in stage Ⅲ was 24 whose 3-year survival rate was 47.1%, the number of patients of combined lobectomy in stage Ⅲ was 11 whose 3-year survival rate was 43.6%, the number of patients of sleeve resection in stage III was 5 whose 3-year survival rate was 40.0%, the number of patients of lung resection in stage Ⅲ was 7 whose 3-year survival rate was 38.1%. There was a significant difference between them in stage Ⅰ in statistically(P=0.006).(5) In the groups with different postoperative functional status(KPS score), the number of patients of equal or greater than 90 points in stage I was 49 whose 3-year survival rate was 93.5%, the number of patients of 80-60 points in stage I was 32 whose 3-year survival rate was 65.4%, the number of patients of 50-30 points in stage I was 3 whose 3-year survival rate was 0.0%; the number of patients of equal or greater than 90 points in stage Ⅱ was 20 whose 3-year survival rate was 84.0%, the number of patients of 80-60 points in stage Ⅱ was 25 whose 3-year survival rate was 36.0%, the number of patients of 50-30 points in stage Ⅱ was 6 whose 3-year survival rate was 25.0%; the number of patients of equal or greater than 90 points in stage Ⅲ was 20 whose 3-year survival rate was 76.0%, the number of patients of 80-60 points in stage Ⅲ was 21 whose 3-year survival rate was 26.8%, the number of patients of 50-30 points in stage Ⅲ was 8 whose 3-year survival rate was 18.8%. The difference between them in stage Ⅰ, Ⅱ, and Ⅲ was significant in statistically(P <0.001、P=0.005 and P <0.001, respectively).(6) In the groups with different weight changes, the number of patients with weight gain in stage Ⅰ was 10 whose 3-year survival rate was 90.0%, the number of patients with weight loss in stage Ⅰ was 7 whose 3-year survival rate of 57.1%, the number of patients with no change in stage Ⅰ was 47 whose 3-year survival rate was 73.5%; the number of patients with weight gain in stage II was 10 whose 3-year survival rate was 90.0%, the number of patients with weight loss in stage Ⅱ was 11 whose 3-year survival rate of 18.2%, the number of patients with no change in stage Ⅱ was 29 whose 3-year survival rate was 59.9%; the number of patients with weight gain in stage Ⅲ was 8 whose 3-year survival rate was 87.5%, the number of patients with weight loss in stage Ⅲ was 17 whose 3-year survival rate of 14.7%, the number of patients with no change in stage Ⅲ was 23 whose 3-year survival rate was 54.3%. The difference between them in stage Ⅰ, Ⅱ, and Ⅲ was significant in statistically(P<0.001 all).3 Because of the different specific chemotherapy regimens, different periods and the different chemotherapy sensitivity due to the individual, pathological type, the difference between whether did chemotherapy after surgery was not significant in stage Ⅱ and Ⅲ in this research(P=0.324 and P=0.728). The survival rate of patients with squamous cell carcinoma could be improved with did chemotherapy after surgery by the further analysis of the pathological type(P=0.003).4 To analyze data according to the COX proportional hazard retrospective model, the results showed: gender(P=0.001), the TNM stage(P=0.007), postoperative functional status(KPS score)(P<0.001), chemotherapy after surgery(P=0.018) were independent factors to influence the survival rate of patients with NSCLC.Conclusions:1 Gender, the TNM stage, postoperative functional status(KPS score), chemotherapy after surgery were independent factors to influence the survival rate of the patients with NSCLC which influenced the prognosis: the female, the earlier pathological stage, the higher the postoperative functional status score, the higher the survival rate, and the postoperative chemotherapy can improve the prognosis, especially for the patients with squamous cell carcinoma.2 For patients with advanced non small cell lung cancer, had a smoking history and whose pathological type was adenocarcinoma, their survival rate was lower. And there was no significant difference between the ways of radical operation, so which way should be selected for the middle and late patients according to their individual situation.Therefore, people with a history of smoking to be at high risk of lung cancer and did physical examination regularly, the seventh edition of TNM stage of NSCLC has important clinical role in guiding. Pay more attention to improve the patients’ nutritional status would help to improve the survival rate after surgery. |
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