Clinical Investigation Of Lung Cancer: A Retrospective Analysis Of 3751 Cases In Zhejiang Province Cancer Hospital

Background:Lung cancer remains a major public health problem worldwide. The increasing incidence of morbidity and mortality attributable to Lung Cancer. It is estimated that carcinoma of the lung will account for 13% of all new cancers in males and 12% of all new cancers in females. Lung cancer is the leading cause of cancer death among females and males, 31% of all cancer deaths in males, and 27% of all cancer deaths in females are attributable to lung cancer. The number one cause of lung cancer is cigarette smoking, representing 85 to 90 percent of all cases, the risk of developing lung cancer is 10 times greater in male smokers than that of non-smokers. Other causes include exposure to radon, asbestos, and arsenic (a byproduct of copper), as well as exposure to passive smoke or 'secondhand' smoke and professional damage. The World Health Organization(WHO) divides lung cancer into 2 major classes based on its biology ,therapy ,and prognosis : non-small cell lung cancer (NSCLC)and small cell lung cancer(SCLC).NSCLC accounts for 80%-85% of all lung cases ,and includes 3 major types :(1) adenocarcinoma;(2)squamous cell carcinoma;(3)large-cell carcinoma. For NSCLC patients are staged ,10% will have stage â… ,20% stage â…¡,30% stage â…¢ and 40% have stage â…£. SCLC accounts for about 15%-20% of all lung cancers compared with NSCLC ,SCLC has a more rapid doubling time . Approximately 67% of patients present with overt metastatic disease outside the chest .SCLC is highly sensitve to initial chemotherapy and radiotherapy. Accurate non-invasive assessment is difficult. So lung cancers are characterized by advanced stages at the time of diagnosis,only be provided by palliative care .The median survival of patients with untreated metastatic non-small-cell lung cancer is only 4 to 5 months, with a survival rate at 1 year of only 10%. Respecting the increasingincidence and the low survial of lung cancer ,we designed this study to investigate the outline and characteristics of 3751 cases of lung ancer from our hospital during the last decade, to analyze the prognostic factors and find some clues for prevention and treatment of lung cancer in future.Aim : To summarise the clinical results of treatment of 3751 cases of lung cancer from our hospital over a period of 10 years and to evaluate the main influencing factors for long-term results.Methods: 3751 patients with lung cancer treated at our hospital were enrolled in this study. The histology of the tumor was described according to the World Health Organization classification,and the stage was defined by the 5^th edition of UICC-TNM staging system .We analyzed the relationship between different modalities of treatment and survial, and evaluated a number of prognostic variables for overall survial including age ,gender, cigarette consumption ,tumor family history, living circumstance ,professional damage, histology, treatment manners, application of platin-containing chemotherapy, and short-term response.Results: The overall 1,3,5 year survial rate was 28.1%,12.3%. 9.2%, respectively .The median survial time was 16.1 months,and the median progress free time was 8.7 months. Cox regression indicated that professional damage , histology , treatment manners , application of platin-containing chemotherapy,and short-term response were the prognostic factors of patients with lung cancer .The results indicated a significant survial benefit with adjuvant chemotherapy only for patients with â…¢ though â…£ non-small cell lung cancer ,and adjuvant radioation only benefited the stage â…¢ non-small cell lung cancer. The third generation cytotoxic drugs in combination with platinum might not benefit compaired with the older platinum containing regimens.we found that patients of non-small cell lung cancer with good functional status and controlled systemic disease, the resection of a single brain metastasis can improve the survial; and patients with bone metastasis ,the resection of primary lung tumor can prolong the overall survial; theimproving survial also was observed in the patients treated by the resection of ipilateral intrapulmonary metastases in resected non-small cell lung cancer.Conclusion:1. Histology, tumor stage, treatment response and professional damage were the factors of compacting the prognostic of lung cancer.2. Appropriate operation , radioation and platin-containing chemotherapy can improve the survial of lung cancer.3. Adjuvant chemotherapy benefited patients with â…¢ though â…£ non-small cell lung cancer.4. Adjuvant radioation benefited the stage â…¢non-small cell lung cancer.5. Patients of non-small cell lung cancer with solitary brain metastasis can obtain a life-prolonging effect from surgical resection;patients with bone metastasis ,the resection of primary lung tumor may improve the overall survial;the resection of ipilateral intrapulmonary metastases in resected non-small cell lung cancer was reasonable.6. Gender ,cigarette consumption ,tumor family history ,living circumstance different sides, TB and COPD companion did not affect the prognosis.