| Objective: Lung cancer is one of the main dangers to human health on a global scale, which is one of the highest cancer mortality and morbidity of the world. According to the pathological type, lung cancer include non-small cell lung cancer, small cell lung cancer. The non-small cell lung cancer accounts for about 85%. Squamous non-small cell lung cancer, the second-largest subtype, accounts for 20-30% of non-small cell carcinoma. Each year about 40 million patients worldwide die from lung squamous cell carcinoma. At present, the treatment of lung squamous cell carcinoma major contain surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, traditional Chinese medicine treatment, and so on. Due to lots of patients who diagnosis as lung cancer has been associated with distant metastasis, the 5-year survival rate is only about 15%.Method: This paper retrospectively analyze the clinical data, treatment modalities, treatment options of 69 patients who were diagnosed with squamous cell lung cancer. We make single factor analysis on these 69 cases, in order to assess prognostic factors of squamous cell lung cancer. The aims of the research are to understand the status of the treatment of squamous cell carcinoma in our department, to collect typical cases, and to find the advantages and disadvantages of treatments which can provide a reference for future clinical treatment.Results: 1 The characteristics of 69 cases The gender of squamous cell lung cancer in our department is predominantly male(81.2%). The age mainly concentrated in between 40 years to 75 years(85.5%). The Karnofsky score is mainly more than 80 points(65.2%). The patients whose smoking index ?400 contain 87.0%. There are 16 patients who have family history of cancer(23.2%). There are 6 cases who have personal history of cancer(8.7%). The images of tumor which showd in central(82.6%) are more than in peripheral(17.4%), and the left side(44.9%) and right(55.1%) was similar occurrence. The tumor stage was mostly III-IV(59.4%). The patients were mostly diagnosed by transbronchial lung biopsy(71.0%), followed by surgical(15.9%), only a small number by percutaneous lung biopsy(11.6%) or pleural effusion sediment diagnosed(1.4%). 2 The mode of treatment The main mode of treatment of 69 cases were surgery, chemotherapy, radiation therapy, or three combination therapy. And some individual has targeted therapy or seed implantation. The surgery patients' tumor stage mostly were IA-IIIA period(85.7%). The surgical procedures are mostly lobectomy(66.7%). The treatment modes were mostly surgery plus adjuvant chemotherapy(61.9%). The adjuvant chemotherapy regimen was mostly gemcitabine plus platinum(52.4%). The tumor stage of patients who could not be performed the operation were mostly IIIB-IV period(72.5%). The first-line chemotherapy regimen mostly were gemcitabine or taxol plus platinum(92.5%). About 57.5% patients did 4 cycles or more(57.5%). The ORR of first-line platinum-based chemotherapy which was more than 2 cycles was 78.8% 2, and more than 4-cycles was 43.5%, and more than 6 cycles was 16.7%. The second-line regimen were mainly docetaxel ± platinum-based chemotherapy(50.0%). 3 The results of DFS OS and single analysis of surgery patients The median DFS of surgery patients was 13.9 months. The median OS was 32.5 months. The 5-year survival rate was 27.8%. Tumor stage and surgical procedures affect DFS. The median DFS of stage I patients was 37.0 months. III patients' median DFS was 10.4 months. IV patients' median DFS was 10.3 months.(P = 0.018). Lobectomy patients' DFS was 21.9 months. Lobectomy and bronchoplasty patients' DFS was 3.6 months. Patients with lobectomy and bronchial pulmonary artery angioplasty had 5.1 months DFS. Lobectomy and bronchial pulmonary artery wedge angioplasty in patients' DFS was 8.2(P = 0.004). 4 The results of PFS OS and single analysis of chemotherapy patients The median PFS in patients with first-line chemotherapy was 6.6 months. The median OS of 40 patients who did chemotherapy was 13.4 months. The 1 year survival rate was 50.6%, and 2-year survival rate was 21.1%. CT finding and distant metastasis at diagnosis were associated with OS prognosis. The median OS of patients whose CT showing central was 16.3 months, while the peripheral was 6.7 months, P = 0.001. The median OS of patients who had no distant metastasis at diagnosis was 16.3 months, while with distant metastasis was 8.1 months, P = 0.003. The other prognostic indicators had no significant difference. 5 Distant metastases There were 18 cases who had single organ metastasis and 9 cases who had multiple organ metastasis. There were 13 brain metastases, 13 cases of bone metastasis, liver metastasis in 7 cases, 3 cases of adrenal metastasis, pericardial metastasis in 2 cases, 1 case of renal metastasis, subcutaneous metastasis in 1 case, 1 case of splenic metastasis. The incidence were as follows: 18.8%, 18.8%, 10.1%, 4.3%, 2.9%, 1.4%, 1.4%. Metastases found at diagnosis were: bone metastasis in 9 cases, 3 cases of adrenal metastasis, liver metastasis in 5 cases, 2 cases of brain metastases, one case of subcutaneous metastasis. Metastases found during treatment were: brain metastases in 11 cases, 4 cases of bone metastasis, 2 cases of pericardial metastasis, liver metastasis in 2 cases, kidney metastasis in 1 case, 1 case of splenic metastasis. We made brain metastases single analysis on patients who did chemotherapy. The OS of patients without distant metastasis was 16.3 months, while OS with brain metastasis was 5.6 months, P = 0.001.The difference was statistically significant. 6 The efficacy and safety of endostar The median OS of chemotherapy combined with endostar was 8.1 months, and 1 year survival rate was 37.5%. The median PFS was 5.1 months. The patients' DCR was 80.0% whose first-line chemotherapy was combined with endostar. The side effects of endostar was blood toxicity, such as I / II anemia 3 cases, III / IV degree leukopenia 1case, degree II neutropenia 1 case, IV thrombocytopenia in 1 case. The non-hematologic toxicity of endostar were degree II nausea and vomiting 2 cases, II / III degree of fatigue in 4 cases, 1 case of mild heart palpitations, oral mucositis two cases, hemoptysis, and no serious side effects are not tolerated. 7 The efficacy and safety of Nedaplatin The assessment of patients who did 4 cylcles or more first-line chemotherapy with Nedaplatin was as follows: SD 2 cases, PD 1 case. The TCR was 66.7%. The assessment of patients who did 4 cylcles or more Second-line chemotherapy with Nedaplatin was PR 1 case, SD 2 cases and PD 1 case. The TCR 75.0%. The hematologic toxicity of Nadaplatin were III / IV degree leukopenia three cases(27.3%), III / IV neutropenia 1 case(9.1%), III / IV anemia in 2 cases( 18.2%), IV thrombocytopenia in 1 case(9.1%). The non-hematologic toxicity were III / IV degree of nausea and vomiting in 1 case(9.1%). No serious liver and kidney dysfunction.Conclusion: 1 The treatment of squamous cell lung cancer were surgery, chemotherapy, radiotherapy. Patients in early stage were recomended surgery. The treatment modes were mostly surgery plus adjuvant chemotherapy. The adjuvant chemotherapy regimen was mostly gemcitabine plus platinum. The advanced patients were recomended first-line chemotherapy. The first-line chemotherapy was mostly gemcitabine + platinum two-drug regimen, followed by taxane + platinum two-drug regimen. If the disease progressed after the first-line treatment, mostly second-line chemotherapy was docetaxel, followed by gemcitabine. There was few patients receiving second-line or third-line therapy. 2 The DFS was associated with surgical stage and surgical procedures. The earlier stage and lobectomy can prolong DFS. 3 The brain, bone and liver were common metastases sites of squamous cell lung cancer, while adrenal, pericardium, kidney, subcutaneous and splenic metastasis were rare. 4 For locally advanced or advanced squamous cell carcinoma of the lung, the OS with distant metastasis at diagnosis is shorter than those without distant metastasis. At the same time, the OS with brain metastases is shorter than those without distant metastasis. 5 First-line chemotherapy with endostar has a better efficiency and security, and endostar can be used to treat squamous cell carcinoma of the lung. 6 Nadaplatin in the first-line treatment of lung squamous cell carcinoma has a better efficiency. It can aslo make clinical benefit in patients who progressed after platinum-based first-line chemotherapy. Nadaplatin has better safety. |
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