Prognostic Factors Of Patients With Lung Cancer

Objective To analyze prognostic factors of lung cancer, and try to find some clues for prevention and clinic treatment of lung cancer in future.Methods The data of 1230 hospitalized patients with lung cancer in Xinqiao Hospital from January 1, 1999 to March 18, 2005 were reviewed, and follow-up was made via post letter, phone-call, and home-visiting in those patients. The end-points of one-year, three-year, or five-year survival were set in accordance with the days when cases were enrolled into this study. The factors which might impact on the patients' prognosis were analyzed including general information of the patients themselves, the tumor data, and different treatment manners. The level of serum vascular endothelial growth factor (sVEGF) was also surveyed with ELISA among the lung cancer patients with different histologic types, tumor stages, and even compared between pre-chemotherapy and post-chemotherapy.Result A total of 1230 cases were enrolled in this study and 1131 of them were followed up to the end-point of the study with 8%(99cases) of loss to follow-up. Among the 1131 patients, 251(22.19%) cases were NSCLC patients in stage â…  and â…¡, or limited stage patients with small cell lung cancer(SCLC); 880(77.81%) cases were NSCLC patients in stage â…¢ and â…£, or extended stage patients with SCLC. The overall one-, three- and five -year survival rates of lung cancer patients treated with operation, chemotherapy or radiotherapy in our hospital were 63.78%, 31.17%, 13.44%, respectively. Fifty-one cases were administrated with neoadjuvant chemotherapy before operation. In patients in stage â…  and â…¡, there was no significant difference of five-year survival rate between neoadjuvant chemotherapy pre-operation (55.68%) and adjuvant chemotherapy post-operation (47.56%). However, the five-year survival rates of stage â…¢a and â…¢b patients with neoadjuvant chemotherapy(35.12% and 25.12%) were higher than that of patients with adjuvant chemotherapy(23.29% and 12.29%, P<0.05). The overall one-, three- and five-year survival rates were found to increase as following order: platinum-based chemotherapy combinedwith radiotherapy, radiotherapy post-operation, operation only, platinum-based chemotherapy post-operation and neoadjuvant chemotherapy pre-operation. Cox Regression indicated that family history, level of sVEGF, tumor stage, operation manner, application of platinum-based chemotherapy and its cycles were independent prognostic factors of patients with lung cancer; the levels of sVEGF of NSCLC patients in stage Ilia, Illb and IV were markedly higher than those of stage I and II patients(P<0.01). There was higher sVEGF level in patients with squamous lung carcinoma compared with the levels of lung adenocarcinoma or SCLC patients (PO.05). Decreased sVEGF was found in the patients well responsive to chemotherapy, especially in complete response patients (P<0.05).Conclusion Tumor family history, level of sVEGF, tumor stage, operation manner, application of platinum-based chemotherapy and its cycles are independent prognostic factors of lung cancer patients. The level of sVEGF is correlated with clinical stage, chemotherapy response and might be used to evaluate prognosis in the patients with lung cancer. Multimodality therapy, especially neoadjuvant chemotherapy, is the most promising treatment in improving long-term survival of lung cancer patients.