| Objective: This essay is a retrospective analysis of patients with wild type epidermal growth factor receptor(EGFR) advanced non-small cell lung cancer(NSCLC) in clinical features, biochemical indicators, pathology and clinical staging, therapeutic measures, to explore the factors affecting the prognosis.Methods: 1. Collect 77 patients with wild type EGFR NSCLC, pathological diagnosis of stage IIIB/IV(AJCC 7th edition),from Liaoning Province Tumor Hospital from June 1, 2010 to July 31, 2014. 2. Collect the patient’s gender, age, weight loss, smoking index, newly diagnosed symptoms, pathological type, ECOG score, distant metastasis, and serum level of carcinoembryonic antigen(CEA), neuron specific enolase(NSE) and cytokeratin 19 fragment(CYFRA21-1), and the treatment measures. 3. The data is statistically analyzed by IBM SPSS 19.0.0, Kaplan-Meier method is used to single factor analysis, and tested by Log rank method. COX model of multiple factors regression analysis independent factors affecting wild type EGFR advanced NSCLC patients prognosis.Results: 1. Clinical characteristics Among 77 cases of wild type EGFR advanced NSCLC patients, more male(66.2%) than female(33.8%), the ratio of male to female is 1:0.51; the distribution of age is from 39 years old to 81 years old, median age 59 ± 9.957 years. The weight loss of 55 cases are less than 5%(71.4%), but 22 cases are greater than or equal to 5%(28.6%). Smoking index is less than 400 in 42 cases(54.5%), greater than or equal to 400 in 35 cases(45.5%). Initial symptoms are cough(62.3%), chest tightness(44.2%), hemoptysis(19.5%), chest pain(18.2%). ECOG score 0-1 points when confirmed in 56 cases(72.7%), 2 points in 21 cases(26%), 3 points in 1 case(1.3%). The most common distant metastasis is bone metastases(32.5%), followed by pulmonary metastases(26%), pleural effusion(26%), brain metastases(14.3%). 2. Pathology and clinical staging, serum tumor markers The most common pathological type in 77 cases of patients is adenocarcinoma(56%), followed by 29.8% for squamous cell carcinoma, adenosquamous carcinoma(3.6%), sarcomatoid carcinoma(2.4%). 17 patients with stage IIIB(22.1%), while 60 patients with stage IV(77.9%). The patients whose serum CEA, NSE, CYFRA21-1 are greater than the upper limit of normal value(UNL) accounted for 29.9%, 59.7%, 75.3% respectively. 3. The treatment measures There are 5 patients(6.5%) neither received chemotherapy nor radiotherapy, 1 patient received radiotherapy alone(1.3%), chemotherapy alone in 44 cases(57.1%), combined radiotherapy and chemotherapy in 27 cases(35.1%). Within the crowd, 6 cases(7.8%) did not received any chemotherapy, 17 cases(22.1%) received 1 kind of drug chemotherapy, 31 cases(40.3%) received 2 kinds of drugs chemotherapy, 18 cases(23.4%) received 3 kinds of drugs chemotherapy, received 4 kinds of drugs chemotherapy in 3 cases(3.9%), 2 cases accept 5 kinds of drugs chemotherapy(2.6%). 4. The survival situation The median overall survival(OS) of patients with wild type EGFR advanced NSCLC is 10.133 months, 1 year survival rate is 37.7%. According to the results of single factor analysis by Kaplan-Meier method, ECOG score, brain metastases, serum NSE level, CYFRA21-1 level, stage of disease, treatment measures, the different kinds of chemotherapy drugs are related to the prognosis of the patients with wild type EGFR advanced NSCLC(P<0.05). However gender, weight loss, smoking status, the distant metastases other than brain, serum CEA level, pathological type(between adenocarcinoma and squamous cell carcinoma) have no connection with the prognosis(P>0.05). Survival time of patients with ECOG 0-1 points is more than ECOG 2 or more points, 12.167 months and 5.700 months respectively; the overall survival without brain metastasis at diagnosis(10.767 months) is longer than with brain metastasis(6.500 months); the overall survival with normal serum NSE/CYFRA21-1 level is longer; survival time of patients with stage IIIB disease(14.767 months) is significantly higher than stage IV patients(9.233 months); cases received combination of chemotherapy and radiotherapy are of the longest survival period(12.233 months); patients who accept the most species chemotherapy drugs(5 kinds) are of the longest survival period, up to 22.167 months. COX multivariate regression analysis showed, stage of disease, the species of chemotherapy drugs and serum CYFRA21-1 level are independent prognostic factors in advanced non-small cell lung cancer with wild type EGFR(P<0.05).Conclusion: 1. More male patients suffered wild type EGFR advanced NSCLC than female, and no connection between sex and pathology; 2. The level of serum CEA in EGFR wild-type NSCLC has low sensitivity, and not its prognostic factors; 3. Patients with wild type EGFR advanced NSCLC should receive various treatment measures like radiotherapy chemotherapy etc., and give full play to the role of different kinds of chemotherapeutic drugs; 4 Stage of disease, the species of chemotherapy drugs and serum CYFRA21-1 level are independent prognostic factors in advanced NSCLC with wild type EGFR... |
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