| Objective:Lung cancer is disease with the highest morbidity andmortality in malignant tumors worldwide.Above75%lung cancer patients,vast majority of whom are advanced lung adenocarcinoma patients,arediagnosed with stage â…¢B or â…£disease,which loss the operation chance. Inrecent years,the reasonable and synthetic application of multidisciplinaryapproach has extended survival of advanced lung adenocarcinoma.It could bepossible to improve the prognosis of lung adenocarcinoma,if we can predictefficacy and prognosis to provide useful references on individual therapy. Weretrospectively reviewed319patients with advanced lung adenocarcinoma inour hospital during the last5years and analysed possible cilinical factorsaffecting the long-term prognosis of patients with this disease, intending to putforward potential cilinical prognostic factors and provide reference for clinicaltreatment.Methods:The data of319cases of stage â…¢B or â…£ lung adenocarcinoma initialdiagnosed by histological or cytological examination in the Fourth Hospital ofHebei Medical University from January2009to May2013was collected inaccordance with the inclusive criteria.319patients had at least one measurablelesion without complication and received no prior treatment includingchemotherapy,radiation, surgery, targeted therapy or immunotherapy,exceptedto survive more than3months.The clinical data including gender,age,smoking, PS scores,family history of cancer,baseline hemoglobin,albumin, neutrophil,peripheral blood T lymphocyte subsets and lactate dehydrogenase levels inserum,TNM stage, bone metastasis,hepatic metastasis,brain metastasis,numbe-rs of metastatic organs,first-line chemotherapy periodicity and therapy withtyrosine kinase inhibitor(TKI)were recorded and an excel database was establ- ished. All the patients were followed-up at least one time during hospital visitor by telephone until December1,2013. Cancer diagnosis is defined as thestarting point,and the last followed-up day,patients death and lost followed-upas the terminal point,dying from lung cancer as the study outcome. Themissing cases, the dead cases for other causes and the survival cases of the lastfollow-up day were managed by the method of censored data. Overallsurvival(OS) is difined as the time from cancer diagnosis to last follow-up dayor dead time.The overall survival time was considered as one of prognosticindicators, the clinicopathological features and potential prognostic factorsof319patients were retrospective analyzed in this paper. Data collected werestatistically analyzed by SPSS13.0statistical software.Kaplan-Meier methodswere used to compute the survival analyses. Use Log-rank test to analyze thefactors of survival time for any significant differences. Kaplan-Meier methodand Cox proportional hazards model were respectively used for univariate andmultivariate analysis,taking P<0.05for statistically significant difference.Results:1In all319patients of advanced lung adenocarcinoma,52cases werediagnosed with stage â…¢B and267cases were stage â…£.174cases of malesand145cases of females were calculated.The median age of319patients aged23-87years was59years old.The follow-up time was2-58months.32patientswere lost follow-up, follow-up rate was90%.In319patients,253casesdied(79.3%) and34patients survived(10.66%) with the median survival timeof13months.One-,two-and three-year survival rates were53%,26.1%and18.1%, respectively.2Univariate analysis showed that PS scores,baseline hemoglobin,album-in, neutrophil levels in serum, TNM stage,bone metastasis, hepatic metastasis,brain metastasis at initial diagnosis,numbers of metastatic organs,first-linechemotherapy periodicity and therapy with tyrosine kinase inhibitor(TKI)hadinfluence on the overall survival of advanced lung adenocarcinoma patients(P<0.05). Cox multivariate analysis showed that PS scores(P=0.000), baselinehemoglobin(P=0.034), albumin(P=0.000), neutrophil(P=0.003), TNM stage (P=0.003), brain metastasis at initial diagnosis(P=0.003), numbers ofmetastatic organs(P=0.000),first-line chemotherapy periodicity(P=0.000) andtherapy with tyrosine kinase inhibitor(P=0.004)were independent prognosticfactors for the overall survival of advanced lung adenocarcinoma.3In83patients of advanced lung adenocarcinoma who received molecu-lar targeted therapy of EFGR-TKI,59cases(71.1%)were treated with gefitinib,17cases(20.5%) received treatment with erlotinib and7cases(8.4%)with co-nmana.In83patients,39cases(47%) received treatment with EGFR-TKI asfirst line therapy and44cases(53%)as second line or more therapy.Insubgroup analysis of83patients of advanced lung adenocarcinoma treatedwith EGFR-TKI, median survival time for11patients(13.3%)treated withEGFR-TKI alone was20months, for49patients(59.0%)who receivedchemotherapy and EGFR-TKI was30months, for17patients(20.5%)whoreceived radiotherapy and EGFR-TKI was20months and for6patients(7.2%)who treated with radiotherapy,chemoradiotherapy andEGFR-TKI was15months. Median survival time for patients who receivedchemotherapy and EGFR-TKI was the longest in all subgroups,presenting nosignificant difference in each subgroup(P=0.344).Conclusion:1PS scores, baseline hemoglobin, albumin and neutrophil in the periphe-ral blood before initial treatment,TNM stage,brain metastasis at initial diagno-sis, numbers of metastatic organs,first-line chemotherapy periodicity andtherapy with tyrosine kinase inhibitor were independent prognostic factors forthe overall survival of advanced lung adenocarcinoma.2The application of EGFR-TKI has extended the lives of patients ofadvanced lung adenocarcinoma and the patients with treatment history ofEGFR-TKI and chemotherapy may benefit most from this kind of treatmentmodality. |
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