| Objective:To analyze the clinical features,survival status and prognostic factors of non-smoking female lung cancer patients in our hospital.Methods:Medical records of 227 non-smoking female lung cancer patients diagnosed and hospitalized in Department of Respiratory Diseases of the Second Affiliated Hospital of Soochow University from January 2011 to December 2015 were reviewed retrospectively.Age,the initial symptom,location and size of the tumor,method of diagnosis,serum level of tumor markers at diagnosis,time to diagnosis,pathological type,EGFR mutation status,tumor TNM staging and the status of distant metastasis at diagnosis,treatment after diagnosis were recorded and analyzed.The influence of the above-mentioned factors on the survival rate of the patients was studied.The survival data were obtained by telephone follow-up.SPSS 23.0 statistical software was used for statistical analysis.The clinical features were described with composition ratio and then ~2inspection.The Univariate survival analysis was performed by Kaplan-Meier method and then Long-rank inspection.Multivariate analysis was applied to COX regression proportional hazards model.p<0.05 indicated statistically significant.Results:1.clinical features:In 227 non-smoking female lung cancer patients,1.32%had a family history of lung cancer and 4.85%had family history of other malignant tumors.The age distribution of patients ranged from 32 to 85 years old,with an average age of 62.09±10.76 years old.With the increase of age,the incidence rate increased initially and then decreased afterwards,the highest incidence of non-smoking female lung cancer(63.87%)was observed round 51-70 years old.The main pathological type determined in this study was adenocarcinoma(74.89%),followed by squamous cell carcinoma(11.45%).The proportion of moderately differentiated adenocarcinoma(65.93%)was significantly higher than other types.55.07%of patients were diagnosed with advanced lung cancer(stage IIIB and stage IV).70.48%of patients manifested symptoms at the time of diagnosis,mainly cough and expectoration(30.84%).29.52%of the patients was found by regular health checkup,among which stage I accounted for 58.82%,stage II accounted for 13.24%,stage III accounted for 2.94%,stage IV accounted for 25.00%of all lung cancer patients.The tumor located in the right side was more than tumor in the left side(60.36%vs.34.8%)with similar incidence of tumor found in the upper lobe and the lower lobe(40.97%vs.40.97%).Tumors with maximum diameter shorter than 3cm(45.5%)were more than those whose diameter ranged from3 cm to 5cm(31.5%)and longer than 5cm(23%),subcentimeter nodules(maximum diameter≤1cm)accounted for 2.50%(5/200).At the time of diagnosis,35.24%of the patients had distant organ metastasis,mainly bone metastasis(55%)and brain metastases(36.25%).55.88%in 68 lung cancer patients who underwent lung cancer driven gene detection was found harboring EGFR-sensitive mutations(exon19 deletion and exon 21 L858 R mutation).Among all the 227 lung cancer patients,123patients(54.19%)underwent surgical treatment,151 patients(53.9%)received chemotherapy,46 patients(20.26%)received the first generation epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs)therapy.2.Survival and Prognostic analysis:The survival time of the 227 non-smoking female lung cancer patients ranged from 1to 84 months,with a median survival time of 21 months.The cumulative survival rates of 1,3,and 5 years were 63%,40.1%,and 30.9%respectively.Univariate survival analysis showed that tumor size(p<0.001),the initial symptoms(p<0.001),tumor TNM stage(p<0.001)and status of distant metastasis(p<0.001)at diagnosis,adenocarcinoma differentiation(p<0.001)and anti-tumor treatment(p<0.001)received were related with the prognosis of non-smoking female lung cancer patients.Multivariate analysis showed that the initial symptoms,poor differentiation,and tumor TNM staging at diagnosis were the independent factors that influence the long-term survival of non-smoking female lung cancer patients.Patients with lung cancer who had initial symptoms were related with worse prognosis.Besides,the higher the TNM staging of lung cancer was determined,the worse the prognosis was.Also,the poorer the differentiation of lung cancer was,the worse prognosis was.Conclusion:1.Lung cancer in non-smoking females were often lack of symptoms or manifest atypical symptoms with high risk of missing diagnosis and misdiagnosis.2.The incidence of non-smoking female lung cancer occurred mostly from 51 to 70 years old.The most common pathological type was adenocarcinoma which was prone to early metastasis.Bone and brain were the most common metastatic sites.3.Lung cancer in non-smoking females diagnosed with compliant of symptom was mostly found at advanced stage(stage IIIB~IV).However,the patients found in regular health checkup were mostly in the early and middle stages.4.The tumor TNM staging,degree of differentiation at diagnosis were independent risk factors influencing the prognosis of non-smoking female patients with lung cancer. |
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