| OBJECTIVE: To retrospectively analyze the clinical features,treatment mode and related factors of 304 patients with squamous-cell lung cancer(SQCLC)in Liaoning Provincial Cancer Hospital.The aim is to combine the clinical cases in the real world to explore the treatment status of stage ?A lung squamous cell carcinoma in Liaoning Provincial Cancer Hospital,collect typical cases,analyze the advantages and disadvantages in treatment,and provide reference for future clinical treatment.Methods:This study retrospectively analyzed the inpatients of the Liaoning Cancer Hospital from September 2010 to September 2015,and screened 304 newly diagnosed patients with stage ?A lung squamous cell carcinoma according to the initial diagnosis.Whether surgery can be divided into the surgery group and non-surgery group.3 years,5 years of disease-free survival(DFS),progression-free survival(PFS)and overall survival(OS)for clinical basic information and treatment status of the impact of the analysis.The follow-up method was to check the medical records,outpatient follow-up,and telephone follow-up.Statistical analysis was performed using IBM SPSS 23.0.0,and single factor analysis was performed using the Kaplan-Meier method and tested by the Log rank method.COX model for multivariate regression analysis of independent factors affecting the prognosis of patients with newly diagnosed stage ?A lung squamous cell carcinoma.Results1.Clinical characteristics Clinical data According to the data collected in this study,the cases of 304 cases of stage ?A lung squamous cell carcinoma were mainly male,with a total of 264 cases(86.8%).The age was mostly over 42 years old,with an average age of 65.219 cases(72.0%)aged over 60 years old;202 cases(66.4%)with smoking index ?400/year;77cases(25.3%)with ECOG score ?2 points;cytokeratin 19 fragment antigen level(Cyfra21-1)>3.3ng/ml in 215 cases(70.7%);in imaging,81 cases(26.6%)were located in the left upper lobe,56 cases(18.4%)in the left lower lobe,right lung There were 69 cases(22.7%)in the upper lobe,33 cases(10.9%)in the right middle lobe,and65 cases(21.4%)in the right lower lobe.Of the 113 patients who underwent radical surgery,29(25.7%)had tumors in the left upper lobe,26(23.0%)in the left lower lobe,and 19(16.8%)in the right upper lobe.There were 7 cases(6.2%)in the middle lobe,32 cases(28.3%)in the right lower lobe;79 cases(69.9%)in the largest diameter of the tumor ? 4 cm;31 cases(27.4%)in the number of ?A-N2 lymph node metastasis ? 3.The number of patients with ?A-N2 lymph node metastasis was ?2 in 35 patients(31.0%);the degree of tumor differentiation was 90 patients(79.6%)with moderate to poor differentiation.2.Treatment mode and program The main treatment methods for stage ?A lung squamous cell carcinoma in our hospital are surgery,chemotherapy,radiotherapy,combined treatment if necessary,and individual targeted therapy.Of the 45 patients(14.8%)who underwent radical surgery,68(22.4%)received preoperative treatment,9(3%)received neoadjuvant chemotherapy,and 66(21.7%)received postoperative surgery.Adjuvant therapy(63patients received postoperative chemotherapy,2 patients received postoperative radiotherapy);117 patients(38.5%)received chemotherapy,12 patients(4.0%)received radiotherapy,received synchronous or sequential chemoradiotherapy Sixty-one patients(20.0%)received anti-vascular targeted therapy(0.3%).Analysis of PFS,OS and influencing factors in 304 patients with stage ?A lung squamous cell cancer.3.Results of DFS,OS and influencing factors in patients undergoing radical surgery The median DFS was 24.9 months for patients undergoing surgery alone,33.1%and 28.1% for 3 years and 5 years,and 35.9 months for median OS.The median DFS was 35.6 months for patients undergoing neoadjuvant therapy combined with surgery.41.1 months;the median DFS was 19.7 months in the combined surgery and adjuvant therapy.The DFS rates were 15.8% and 9.5% in the 3 and 5 years,respectively,and the median OS was 36.4 months.Univariate analysis showed that the maximum diameter of the tumor,the number of N2 lymph node metastases,the number of N2 lymph node metastasis groups,and whether postoperative adjuvant therapy were associated with DFS.79 patients(69.9%)had a maximum tumor diameter ? 4 cm,a median DFS was17.6 months(P=0.036),31 patients(27.4%)had N2 lymph node metastasis ? 3,and a median DFS was 13.7 months(P= 0.002);N2 lymph node metastasis group ? 2 group35 cases(31.0%),median DFS was 15.4 months(P = 0.002).The T stage,the maximum diameter of the tumor,the number of N2 lymph node metastases,and the number of N2 lymph node metastasis groups were associated with OS.The T2 stage was 61 cases(54.0%),the median OS was 31.7 months(P=0.023);the median OS of the tumor with a maximum diameter of ?4 cm was 30.0 months(P=0.042);the number of N2 lymph node metastasis was ?3 The OS was 18.2 months(P<0.001);the median OS of the N2 lymph node metastasis group was 23.7 months(P<0.001).Combined with Cox multivariate analysis,patients with N2 lymph node metastasis ? 3 had a higher risk of postoperative mortality(P < 0.001),and patients with lymph node metastasis < 3 had no significant difference in mortality risk.Neoadjuvant therapy combined with radical surgery did not prolong DFS(P=0.140)and OS(P=0.108).The combination of radical surgery and adjuvant therapy alone did not prolong the overall survival of patients(P=0.723).However,it was meaningful for the prolongation of DFS in patients(P=0.049).4.Analysis of PFS,OS and influencing factors in non-surgical patients The median PFS was 12.6 months in the first-line chemotherapy patients,and the median OS was 22.8 months.The median PFS was 25.5 months in patients receiving radiotherapy,and the median OS was 32.4 months.The median PFS was 15.0 in patients with synchronous or sequential chemoradiotherapy.The median OS was 31.8months,and the 3-year and 5-year survival rates were 44.6% and 28.2%,respectively.The median OS of patients treated with TKI was 36 months.Univariate analysis showed that the tumor site and first-line treatment regimen were associated with PFS and OS in patients.The tumor was located in the right upper lobe in 50 patients(26.2%),the median PFS was 22.4 months(P=0.018),and the median OS was 34.3months(P=0.008).Combined with Cox multivariate analysis,tumor site was an independent risk factor for PFS in non-surgical patients(P=0.012).Synchronous or sequential chemoradiotherapy significantly prolonged the overall survival of patients with stage ?A lung squamous cell carcinoma who were unable to undergo surgery(P=0.005).5.Analysis of factors affecting survival prognosis in patients with stage ?A lung squamous cell cancer The median DFS was 21.8 months in patients undergoing radical surgery.The 3D and 5 years DFS rates were 23.2% and 16.0%,respectively.The median OS was 34.9months.The 3-year and 5-year survival rates were 51.9% and 39.8%,respectively.The median PFS was 14.1 months in patients with non-radical surgery,the incidence of PFS was 11.5% and 9.7% at 3 and 5 years,and the median OS was 26.3 months.The 3-year and 5-year survival rates were 34.2% and 21.9%,respectively..Univariate analysis showed that whether or not to undergo radical surgery is an independent factor affecting the prognosis of patients.Tumor location and T stage may be related to PFS and OS of patients.The tumor was located in the right upper lobe of 69 cases(22.7%),the median PFS was 23.9 months(P=0.076),the median OS was 37.9 months(P=0.047),the T1 stage was 20 cases,and the median PFS was 25.4 months.(P=0.091),the median OS was 47.6 months(P=0.046).Combined with Cox multivariate analysis,radical surgery is a factor affecting PFS and OS in patients with stage ?A lungsquamous cell carcinoma,which can significantly improve short-term efficacy and prolong long-term survival(P=0.014).Conclusion1.The tumor size,location and lymph node metastasis of patients can be used as an important index to evaluate the prognosis of patients with stage ?A lung squamous cell carcinoma undergoing radical surgery.The number of mediastinal N2 lymph node metastasis is an independent factor affecting the postoperative survival rate of patients with stage ?A lung squamous cell carcinoma.Postoperative adjuvant therapy can significantly improve the incidence of DFS in patients 3 and 5 years after surgery,but does not prolong the overall survival of patients.2.Tumor location is an independent prognostic factor affecting the survival rate of non-surgical patients.Synchronous or chemoradiotherapy can significantly prolong the overall survival of patients.3.The main treatment for patients with stage ?A lung squamous cell carcinoma in our hospital is based on surgery,chemotherapy and radiotherapy.Tumor location and T stage can be used as indicators to assess patient prognosis. |
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