Effect Of EGFR-TKI Treatment On The Prognosis Of Stage ? Lung Adenocarcinoma With Chronic Obstructive Pulmonary Disease With High Secretion Of Sputum And Mucus

Purposes:1.To investigate the status of clinical diagnosis of lung cancer patients with COPD in the Department of Respiratory Medicine of Subei People's Hospital;2.To study the CAT score,m MRC grade and PS score before and after treatment of patients with stage IV lung adenocarcinoma complicated with COPD with high mucus secretion treated by EGFR-TKI,to evaluate the changes in clinical symptoms and quality of life of patients with cough and expectoration;3.To study the progression-free survival of EGFR-TKI in the treatment of stage IV lung adenocarcinoma patients with COPD and mucus hypersecretion.Methods:1.A total of 873 patients diagnosed as lung cancer by pathology from January 2016 to August 2019 in the Department of Respiratory Medicine from the patient's electronic medical records,telephone follow-up,and inquiries through the HS system of Subei People's Hospital.Collect and record its general clinical data: including name,gender,age,contact information,chief complaint,symptoms and signs,smoking history,previous lung disease history,chest CT,lung function,pathological type,TNM staging,genetic test results,treatment plan,etc.2.Screened from 873 lung cancer patients:(1)patients diagnosed with COPD by lung function test results;(2)patients have not undergone lung function test,according to their age,gender,smoking,symptoms and signs,imaging test results,past Pulmonary medical history,highly suspected COPD;(3)patients with high mucus secretion according to the cough and sputum evaluation questionnaire;(4)clinical staging of stage IV,pathological type of adenocarcinoma,EGFR mutation-positive TKI targeted therapy.3.Group the patients,group A is the TKI targeted treatment group of IV lung adenocarcinoma;group B is the targeted treatment group of IV lung adenocarcinoma with mucus hypersecretion TKI;group C is the TKI target of stage IV lung adenocarcinoma with COPD Treatment group;Group D is the target treatment group of IV lung adenocarcinoma with COPD and mucus hypersecretion TKI.4.Calculate the diagnosis rate and proposed diagnosis rate of lung cancer patients with COPD,and analyze the diagnosis status of lung cancer patients with COPD.Calculate the proportion of patients with high mucus secretion in lung cancer or lung cancer with COPD.Record the progression-free survival of the four groups of patients after targeted therapy,record the CAT score,m MRC grade,PS score of patients with stage IV lung adenocarcinoma with COPD and high mucus secretion before and after TKI treatment,and analyze the prognosis of TKI treatment by statistical methods Impact.Results:1.(1)Among 873 lung cancer patients,139 patients were diagnosed with lung cancer and COPD by lung function examination,accounting for 15.92% of the total number of lung cancer.(2)The patient has never done lung function,but based on the patient's age,gender,symptoms and signs,smoking history,previous lung disease history,occupation,imaging chest CT/PET-CT examination results,etc.,285 patients with COPD are highly suspected.The proposed diagnosis rate of COPD is about 48.57%.(3)Among the 873 lung cancer patients,387 had high mucus secretion,accounting for44.33% of the total number;of the 139 lung cancer patients with COPD,91 had high mucus secretion,accounting for 65.47%.2.The CAT score,m MRC grade,and PS score of EGFR-TKI treated patients with IV lung adenocarcinoma complicated with COPD with mucus hypersecretion after treatment were significantly different from those before treatment(P<0.001).3.Of the 873 lung cancers,136 were positive for stage IV lung adenocarcinoma with EGFR mutations and used TKI targeted therapy.A total of 20 patients who were degrouped and died during the follow-up process were excluded,and 116 were includedin the study.Among them,there were 38 people in group A,32 people in group B,25 people in group C,and 21 people in group D.m PFS in group A was 11.10 months;m PFS in group B was 7.25 months;m PFS in group C was 8.50 months;m PFS in group D was 4.90 months.After TKI targeted therapy in four groups of ABCD,m PFS was compared between groups.Except for m PFS between BC and two groups(P>0.05),the difference was not statistically significant,and m PFS between other groups was statistically significant.(P<0.05).Conclusions:1.The diagnosis rate of lung cancer combined with COPD in the respiratory department of Subei People's Hospital is only 15.92%,and the proposed diagnosis rate is 48.57%.In the clinical diagnosis of lung cancer with COPD,there are still irregular diagnosis and missed diagnosis.The possible missed diagnosis rate is 32.65%.2.EGFE-TKI targeted therapy can improve the clinical symptoms and quality of life of patients with stage IV lung adenocarcinoma combined with COPD and high mucus secretion.3.PFS of patients with stage IV lung adenocarcinoma is shortened once it has COPD or accompanied by high mucus secretion;when patients with stage IV lung adenocarcinoma combined with COPD is accompanied by high mucus secretion,the PFS of the patient is significantly shortened.