Analysis Of Clinicopathological Features And Prognosis Of 233 Patients With Stage ? Non-Small Cell Lung Cancer

Objective: Retrospectively analyze the clinical pathological features of stage I NSCLC(Non-small cell lung cancer)in our hospital and study the prognostic factors.Methods: Collecting the medical records of 233 patients with stage I nonsmall cell lung cancer who underwent surgery at the Affiliated Tumor Hospital of Guangxi Medical University from January 2006 to December 2013.Record the first symptoms,sex,age,smoking history,preoperative platelet(PLT),preoperative hemoglobin(HGB)concentration,preoperative carcinoembryonic antigen(CEA)concentration,surgical method,including Thoracotomy and Video-assisted thoracoscopic surgery(VATS),lymph node dissection,tumor size,tumor location,pathological type,differentiation degree,visceral pleura invasion(VPI),vessel invasion(VI),including blood vessel invasion(BVI)and lymphatic vessel invasion(LVI),adjuvant chemotherapy,survivalsituation and study the influence of the above factors on the survival rate of the patients.Follow up by telephone,clinic and so on,query the data of our hospital follow-up office and get survival data.Using SPSS17.0 statistical software,the clinical pathological features were described by composition ratio,the life table method was used to calculate the cumulative survival rate of 1,3,and 5 years of the whole group,the single factor survival analysis was performed by KaplanMeier(Log-rank test),multivariate analysis was applied to COX regression model.X2 test was used to evaluate the relationship between VI,VPI and other clinicopathological features.P < 0.05 was statistically significant.Result :1.Clinical pathological characteristicsThe incidence of male patients(57.9%)was slightly higher than that of female patients(42.1%),and the ratio of male to female was 1.4:1.With the increase of age,the incidence rate increased first and then decreased,the incidence of 51-70 years was highest(70.9%).The first symptom was cough(53.6%),followed by expectoration.Active smokers were 91(39.1%),nonsmoking patients were 142(60.9%),the proportion of male smokers was significantly higher than that of female(65.2%VS3.1%).The tumor was located in the right lung more than the left side(58.4%VS41.6%),the upper lobe was more(59.6%).Stage Ia(71.2%),stage Ib(28.8%).The maximum tumor diameter < 3cm(54.9%)is slightly more than?3cm,?5cm(45.1%).The main pathological types were adenocarcinoma(76.0%),followed by squa mous cell carcinoma(15.5%).High differentiation(67.8%)was higher than low differentiation(32.2%).BVI(4.7%),LVI(4.3%),VPI(9.0%),the proportion is all small.HGB < 110g/L(7.7%),PLT>300×109/L(18.0%),CEA>5.0?g/L(32.2%),the proportion of the total cases were smaller.Thoracotomy in 146 cases(62.7%),VATS in 87 cases(37.3%).mediastinal lymph node dissection>3 groups were 178 cases(76.4%).Total number of lymph nodes dissection > 6 pieces were 206 cases(88.4%).Adjuvant chemotherapy in 49 cases(21.0%).2.Survival and prognostic analysisThe survival rate of 1,3and 5 years were 96.5%,88.8%,77.0 %.Univariate survival analysis showed that gender,smoking,HGB,PLT,CEA,surgical method,tumor location and VPI have no significant effect on the prognosis of patients(P>0.05).Age,tumor size,TNM stage,T stage,pathological type,differentiation degree,VI,groups of mediastinal lymph node dissection and total number of lymph nodes dissection were related to the prognosis of patients(P<0.05).Multivariate analysis showed that the maximum diameter of the tumor is larger than 3cm,less than 5cm,low differentiation,VI,groups of mediastinal lymph node dissection < 3 and total number of lymph nodes dissection<6 are independent risk factors for prognosis.3.Patients with stage Ib NSCLC cannot benefit from adjuvant chemotherapy after surgery.4.VI is more common in poorly differentiated tumors.Conclusion :1.Age,tumor size,TNM stage,T stage,pathological type,differentiation degree,VI,groups of mediastinal lymph node dissection and total number of lymph nodes dissection are closely related to the prognosis of stage I NSCLC.The maximum diameter of the tumor is larger than 3cm,less than 5cm,low differentiation,VI,groups of mediastinal lymph node dissection<3 and total number of lymph nodes dissection<6 are independent risk factors forprognosis,adjuvant chemotherapy is recommended for high-risk patients to prolong long-term survival.2.There was no significant difference in the survival of stage I NSCLC by VATS and thoracotomy.3.Stage Ib NSCLC cannot benefit from adjuvant chemotherapy after surgery,may benefit some patients with high risk factors.4.VI is more common in poorly differentiated tumors.