| Objective:With the improvement of living environment and medical conditions,China has gradually stepped into an aging society.The incidence of malignant tumors is increasing day by day,in which the lung cancer ranks very high.The diagnosis and treatment of this special group of patients have always been controversial.This study focuses on analyzing the characteristics of clinical diagnosis and treatment of elderly patients with lung cancer,the impacts of different general factors and treatment intervention methods on the overall survival of them on the real world,and explores how to choose an appropriate diagnosis and treatment scheme to benefit more elderly patients with advanced lung cancer to provide guidance for them to improve their prognosis.Methods:In this thesis,a single-centered retrospective analysis is conducted on the medical records of 149 elderly and advanced lung cancer patients hospitalized in the Department of Oncology and Respiratory Medicine of the First Affiliated Hospital of Jinan University from March 2015 to July 2020.The analysis studies how the process of diagnosis,the status of the patients,the stage of disease development and the choice of treatment affect the prognosis of the patients.The Kaplan-Meier Method of the Chinese version of SPSS 26.0 statistical software is adopted to analyze the survival data.The Cox Proportional Risk Regression Model is used to analyze and determine the risk factors.When P<0.05,it is considered to be statistically significant.GraphPad Prism 8.0.2 professional drawing software is used to make histograms or survival curves.Results:The medium age of 149 elderly patients is 80-year-old(75-94),including 105 males and 44 females.Among them,44 cases(29.5%)were confirmed by histopathology,non-small cell lung cancer(NSCLC)accounted for 77.3%,and patients with stage IV accounted for 86.4%.The 1,2,3,4 PS score accounted for 15.9%,50.0%,27.3%and 6.8%,respectively.Only 28 cases(63.6%)received tumor treatment.The remaining 105 cases(70.5%)failed to obtain pathological diagnosis,in which 80 cases(76.2%of the patients)gave up treatment and were discharged directly,and the rest received antineoplastic therapy.The gene detection rate of the whole group was 10.1%,and the PD-L1 detection rate was 4.5%.Analyze 69 cases of patients receiving antineoplastic therapy,including 44 patients with confirmed pathological types and 25 patients with unconfirmed pathological types but were still treated with antineoplastic therapy.The Median Survival Time(MST)was 10.4(0.8-51.9)months,and the 6-month,12-month and 24-month survival rate was 69.6%,34.8%and 7.2%,respectively.Compared by gender,the MST of male cases was 9.2(0.8-37.9)months,and the MST of female cases was 14.2(0.8-51.9)months.As P=0.262,indicating that the gender difference was not statistically significant.The MST of pathologically diagnosed cases is 12.2(0.8-51.9)months,and the MST of clinical diagnosed cases is 9.1(0.8-27.9)months.As P=0.014,the difference in diagnostic methods is statistically significant.The MST of stage Ⅲ B cases was 26.4(5.2-51.9)months,and the MST of stage IV cases was 10.2(0.8-37.9)months.As P=0.018,the difference of tumor stages was statistically significant.Compared by PS scores,the MST of the patients with PS score 1 was 10.5(4.8-25.4)months,the MST of patients with PS score 2 was 9.9(0.8-51.9)months,the MST of patients with PS score 3 was 12.3(2.7-17.7)months,and the MST of patients with PS score 4 was 1.7(0.8-5.1)months.The MST of patients with 1-3 PS score is significantly longer than patients with 4 PS score(P<0.01).There was no significant statistical difference between the MSTs of PS scores of 1-3.The clinical data of the 69 patients were analyzed by the COX Multivariate risk regression model,and there were three variables that could be introduced into the model,namely,diagnosis mode,PS score and treatment intervention mode.The fact that HR>1 of these three factors indicates that they are risk factors affecting the overall survival of elderly patients with advanced lung cancer.In the case of the same PS score and treatment intervention,only the death risk of clinical diagnosis was 2.03 times higher than that of pathological diagnosis;in the case of the same diagnosis and treatment intervention,each 1-point increase in PS score was associated with a 1.62-time increase in the death risk of patients;in the case of the same PS score and diagnosis,the death risk of patients who received supportive treatment alone was 2.29 times higher than those who received anti-tumor therapy.Of all the 34 cases of patients with advanced non-small cell lung cancer in the group,13 cases(38.2%)of them refused to receive acupuncture intervention therapy.The impacts of different treatment methods on the overall survival time of elderly patients are as follow:the MST of patients only receiving supportive treatment was 10.8(0.8-17.7)months and the MST of patients receiving anti-tumor treatment was 15.2(0.8-51.9)months.As P=0.025,the difference between the two was statistically significant.The MST of patients with targeted mutations and taking targeted drugs was 26.4(0.8-37.9)months.Compared with supportive therapy alone,as P=0.015,the difference was statistically significant.Of the 44 pathologically confirmed patients,10 were small cell lung cancer,and the overall MST was 8.4(1.3-17.1)months.In the pathologically confirmed group,43.2%of the patients had a PS score of 3-4.The MST of these patients treated with supportive therapy only was 9.1(1.1-11.4)months,and the MST of patients treated with anti-tumor therapy was 12.2(0.8-17.7)months.As P=0.137,there was no significant statistical difference between the two groups.Conclusions:1.This study shows that in the group of elderly patients(≥75 years-old)with lung cancer,the rate of pathological diagnosis is very low,and 70%of them fail to receive normal diagnosis,which indicates that diagnosis and treatment needs to be further improved;in the case of the patients who obtaining pathological diagnosis,only a small number of them undergo molecular detection,which brings difficulties to the follow-up stratified treatment and thus missing the opportunity to improve the prognosis.2.Diagnosis,PS score and treatment intervention may be risk factors affecting the overall survival,while gender and TNM stage(ⅢB and Ⅳ)have little influence on the overall survival.3.Some patients with advanced NSCLC who have good comprehensive evaluation results can benefit from anti-tumor therapy and have a better prognosis than supportive therapy alone.4.Most of the elderly patients with lung cancer suffer complicating diseases,and the PS score of one third of them ranges from 3-4.The prognosis of these patients was not improved after anti-tumor therapy,so BSC may still be an appropriate choice. |
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