Survival Characteristics Of Non-small Cell Lung Cancer With Different Clinical And Pathological Features And Survival Analysis Of Anticoagulant Treatment

Objective: lung cancer incidence of malignant tumors accounted for the first in our country,each year 705000 new cases,the death toll from the lung cancer caused by top of about 569000 per year.Malignant tumor patients often show hypercoagulable state,concurrent thrombosis related to an increased risk of disease,such as deep vein thrombosis(DVT)and pulmonary embolism(PE)and arterial occlusion related stroke and angina.Incidence of lung cancer in the malignant tumor complicated with thrombosis ranked third,and sometimes the patient does not appear thrombosis had showed blood coagulation abnormalities and the activation of blood coagulation system.Thrombus formation not only seriously affect the quality of life but also shorten the survival in cancer patients died of vein thrombosis,its mortality rate is second followed the disease itself.Currently anticoagulant drugs has been suggested a number of international organizations applied to the treatment of cancer,thrombosis,China also has guidelines recommend.Today,more and more research began to focus on anticoagulant drugs have anti-tumor activity,cell adhesion and tumor metastasis,invasion and thrombus formation,immune escape,but specific pathological mechanism is not clear.This study retrospectively analyzed the clinical data of patients with non-small cell lung cancer to explore the role of anticoagulant drugs in controlling the disease,in order to provided evidence for the anticoagulant drugs to improve survival in patients with NSCLC.Methods: This study collected the first visit to the Fourth Hospital of Hebei Medical University by pathology or cytology confirmed 876 cases of non-small cell lung cancer in January 2008 to December 2014 period,the original cases were collected,the contents include the basic clinical and pathological features and blood coagulation function index(PT,PA,PIR,INR,APTT,Fib,TT,part live clotting enzyme time ratio,ratio of thrombin,D-2,platelet count),patents divided two group according to anticoagulant drugs.By telephone,hospital,department of information and other ways to get follow-up,the follow-up deadline is December 15,2015.The primary endpoint was overall survival time(Overall Survival,OS): From Pathology confirmed NSCLC first day to the time of death or last follow-up time is defined as the OS.IBM SPSS 23.0 statistical software to analyze data applications.Descriptive analysis using frequency;The comparison of measurement data using statistical description of the median and standard deviation with t-test method to compare differences between the two groups;Count data using statistical description of constituent ratio and chi-square test were compared;The Kaplan-Meier describes survival,depicting the survival curves;The Log-Rank method to test whether each survival curve has significant;COX regression to describe risk factors.Set P < 0.05 for the test of significance level.Results: 1 This study retrospectively analyzed 876 NSCLC patients and 270 patients were treated with the anticoagulant therapy,606 did not.The overall median survival time was 15.1 months,patients with 1,2,3,5 years survival rate were 59.7%,33.3%,23.4% and 13.9% respectively.Nonanticoagulant group of median survival was 14.2 months,patients with 1,2,3,5 years survival rate were 56.6%,31.8%,21.0% and 12.6% respectively.Anticoagulant group of median survival was 17.7 months,patients with 1,2,3,5 years survival rate were 66.6%,36.6%,28.8% and 16.8% respectively.The median OS and 1,2,3,5 years survival rate are extended in anticoagulation group compared with another,Log Rank comparative results for P = 0.016.2 single factor analysis.In addition to the anticoagulant therapy can significantly improve survival,women(P = 0.005),less than 65 years of age(P = 0.012),adenocarcinoma(P = 0.000),TNM stage(P = 0.000),no history of smoking(P = 0.011),hypertension(P = 0.001),surgical treatment history(P = 0.000),history of CVC(P = 0.000)prolong the survival time.3 COX regression analysis of multiple factors of anticoagulant drugs is not the risk factor affecting survival(P = 0.085),while age(P = 0.013),pathological type(P = 0.000),TNM stage(P = 0.000),smoking history(P = 0.007),hypertension(P = 0.013),history of surgery(P = 0.000),CVC(P = 0.019)as an independent risk factor for survival.4 Log – Rank of stratified analysis.stratified analysis by various factors drawn men aged ? 65 years old,squamous cell carcinoma,?,? stage,smoking,non-diabetic,non-atherosclerotic,non-hepatitis anticoagulant in patients with OS was significantly longer than those without anticoagulant The difference was statistically significant.Conclusion:1 Anticoagulant therapy can improve survival,extend the median OS 3.5 months,especially in factors of male,age ? 65,squamous cell carcinomas,?,? stage,smoking,non-diabetes,non-atherosclerosis,non-hepatitis.Application of anticoagulant drugs significantly prolong OS.2 Femal,younger,adenocarcinoma,no smoking history,basic diseases including hypertension,history of surgery,has a history of CVC,the earlier stage of patients survival time was significantly prolonged.3 Age,pathological type,TNM stage,smoking history,history of hypertension,surgical treatment history,CVC were independent risk factors for lung cancer survival.