| Objective:1.To compare differences survival time of patients with advanced non-small cell lung cancer(NSCLC) in the practical work, analyze its influencing factors.2.Preliminary analysis on effect of drugs used for patients with advanced NSCLC in the practical work. Methods:764 patients with dvanced NSCLC seen in respiratory medicine department of Xijing Hospital between March 2011 and June 2013 were enrolled in this study. We analyzed OS according to the treatment and genders.Analyze clinical features including age, sex, smoking history, tumor stage, PS scores, pathologic types and compare different effect of drugs in treatment 638 cases advanced NSCLC in the practical work. Survival curves were constructed using the Kaplan-Meier method and differences between survival curves were evaluated by the log-rank test and Cox regression. Differences were considered significant if P<0.05. All the calculations were performed in SPSS 18.0. Results:1. Survival influence factors: MST from all patients was 10.2 months(95%CI, 9.3-10.9), 1 year and 2 year survival rate were 44.2% and 18.1%, MST in patients receiving treatment for 12.0 months(95%CI, 9.2-14.8), Patients with untreated MST of 6.4 months(95%CI, 4.3-8.5), there is statistical significance(P<0.01).Whole group male patients with MST was 9.3 months(95%CI, 8.3-10.2), whole group female patients with MST was 11.5 months( 95%CI, 10.1-12.9), there is statistical significance(P=0.048). Male patients with MST was 9.8 months(95%CI, 9.1-11.5), and female patients with MST was 12.4months(95%CI, 10.9-14.5)in treatment group,there is statistical significance(P=0.039). Analysis of the different PS score, PS score of 0 patients with MST was 12.0 months(95%CI, 9.2-14.7), PS score of 1 patients with MST was 10.3 months(95%CI, 9.4-11.2), There is statistical significance(P=0.021). Analysis of different according to the tumor stage, IIIB patients with MST was 11.3 months(95%CI, 10.5- 12.1), IV patients with MST was 10.2 months(95%CI, 9.3-11.0), there is not statistical significance(P=0.350). Whatever smoking and age is not statistical significance(P=0.110 and P=0.406). Analysis of different pathological types, adenocarcinoma with MST was 13.5 months(95%CI, 11.8-15.2), squamous cell carcinoma with MST was 10.6 months(95%CI, 9.3-11.9), there is statistical significance(P=0.004). Multivariate analysis showed that gender, the tumor stage, PS score, pathologic types have prognostic significance.2. The effect of drugs: ①Compared with two groups the targeted drug-free therapy in patients with adenocarcinoma, one group first-line chemotherapy of docetaxel combined with platinum, the other group first-line chemotherapy of pemetrexed combined with platinum, the MST were 13.6, and 12.2 months respectively, there is not statistical significance(P=0.084). ②Compared with two groups the targeted drug-free therapy in patients with squamous cell carcinoma, one group first-line chemotherapy of docetaxel combined with platinum, the other group first-line chemotherapy of gemcitabine combined with platinum, the MST were 12.1, and 10.8 months respectively, there is not statistical significance(P=0.185). ③Compared with accepted one, two and three programmes, the MST were 7.1, 10.3 and 14.9 months respectively, there is statistical significance(P=0.046). Pairwise comparison of overall survival showed, a comparison of one and two programmes(P=0.527), one and three programmes(P=0.023), two and three programmes(P=0.026). ④As with targeted drugs involved in chemotherapy compared to chemotherapy alone, MST of patients with chemotherapy alone was 9.0 months(95%CI, 8.6-11.2), MST of patients with targeted drugs involved in chemotherapy was 11.0months(95%CI, 9.9-12.6), there is statistical significance(P<0.001). ⑤MST of patients with effective detection of EGFR gene mutation-positive, effective detection of mutation-negative and without genetic testing are 17.1 months, 10.8 months and 16.8 months, pairwise comparison of single factor analysis, there is not statistical significance(P>0.05), multivariate Cox regression analysis is statistical significance(P=0.004). ⑥When the progress of first-line chemotherapy non-squamous cell carcinoma patients, given the second-line chemotherapy, MST of patients was 16.6 months(95%CI, 8.7-24.5), given the second-line targeted drugs, MST of patients was 21.3 months( 95%CI, 16.4-26.2), there is statistical significance(P=0.043). Conclusion:1.Gender, tumor stage, PS scores, pathologic types and whether treatment measures can affect the overall survival of patients, but age and smoking have little effect on overall survival of patients.2.Selecting different chemotherapy drugs in the first line treatment has little effect on prognosis, in the absence of targeted therapy in advanced adenocarcinoma and squamous cell carcinoma.3.Patients with advanced NSCLC get benefit from chemotherapy plus targeted therapy.Three types of chemotherapy prolong longer survival time than one or two chemotherapy. Combined targeting drugs has better OS than single chemotherapy in second-line treatment of patients progress following standard chemotherapy with advanced non-squamous cell carcinoma. |
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