| Objective.To clarify the risk factors associated with the prognosis of NSCLC patients at the time of first diagnosis by retrospectively observing the clinical characteristics of our patients with stage Ⅲ-Ⅳ non-small cell lung cancer(NSCLC)in the era of targeted therapy,conducting univariate and multifactorial analyses of multiple factors that may affect overall survival time,and providing clinical stage Ⅲ-Ⅳ NSCLC patients’ diagnosis,treatment,and prognosis assessment by providing reference materials.Methods.The clinical data of 376 patients admitted to Huaihe Hospital of Henan University from January 1,2016 to January 1,2020 with first pathologically confirmed diagnosis and clinical stage Ⅲ-Ⅳ NSCLC were collected and collated,and the basic data of patients were recorded including: age,gender,smoking status,BMI,PS score,personal history of respiratory diseases,and family history of malignant tumors;tumor characteristics including.Tumor location,pathological type,organ metastasis,presence or absence of pleural effusion,clinical stage of tumor,and type of gene mutation;test indexes including: CEA,serum albumin and PLR,NLR;treatment strategy: with or without targeted therapy,etc.Survival status or time to death was informed through case follow-up,outpatient follow-up and telephone follow-up,and the total survival time was calculated for all patients.Subsequently,the survival data were analyzed,and the survival rates at 1,2and 3 years were calculated,and single-factor prognostic analysis was performed,and Kaplan-Meier was applied to derive the survival curves,which were subjected to Log-rank test.The independent influencing factors of survival prognosis were considered to be statistically different at P < 0.05.Results.1.clinical characteristicsThe youngest of 376 patients with stage Ⅲ-Ⅳ NSCLC was 26 years old and the oldest was 87 years old,with the highest incidence rate in the age range of 61-70 years(138/376,36.7%)and a mean age of 63 years.The male to female ratio was 1.39:1.171 patients(171/376,45.5%)were smokers,of whom more than four-fifths had a smoking index ≥400(142/171,83.0%).208 patients belonged to the normal body composition(208/376,55.3%).35.9%(135/376)of patients had combined respiratory diseases,61 patients had a combined family history of malignancy(61/376,16.2%).Cough and sputum(155/376,41.2%)was the most common first symptom,and the primary focus of the tumor was located in the right lung in more than half of the patients(205/376,54.5%).At the time of diagnosis,150 patients(150/376,39.9%)had pleural effusion,208 patients(208/376,55.3%)had organ metastases,and the most commonly involved sites were lung,bone,and brain.295 patients(295/376,78.5%)had stage Ⅳ disease at the time of diagnosis.Pathological type: adenocarcinoma accounted for 74.2%(279/376),followed by squamous carcinoma with25.3%(95/376).Genetic testing was performed in 214 patients(214/376,56.9%),of which EGFR mutations were the most frequent,with 129(129/214,60.2%),followed by ALK fusion mutations in 11(11/214,5.1%),and the rest were seen in ROS-1 rearrangements,TP53 mutations,MET-exon14 deletions,KRAS mutations,and EGFR and ALK double mutations,and EGFR and TP53 double mutations.Among patients with EGFR mutations,the most common was 19-Del mutation(51.2%),followed by 21-L858 R mutation(42.6%),with coexistence of both mutations within the EGFR gene.204 patients(204/376,54.3%)were in the CEA elevation group(>6.5 ng/m L)and 136 patients with low serum albumin(136/ 376,36.2%).Targeted therapy was applied in 152 patients(152/376,40.4%).2.Prognostic analysisAmong the 376 NSCLC patients followed up to January 1,2022,275(275/376,73.1%)died and101(101/376,26.9%)survived,with a 1-year survival rate of approximately 75.0%,a 2-year survival rate of approximately 50.0%,and a 3-year survival rate of approximately 36.7%.Univariate prognostic analysis: age,gender,smoking status,personal history of respiratory disease,presence of pleural effusion,organ metastasis,pathological type,clinical stage of tumor,targeted therapy,CEA,PLR,NLR,and serum albumin were associated with overall survival time of patients with stage Ⅲ-Ⅳ NSCLC,and the differences were statistically significant(P < 0.05);BMI,family history of malignancy,PS score,tumor location,and gene mutation status did not show statistically significant effects on overall survival time(P > 0.05).COX multifactorial prognostic analysis: smoking status,pathological type,clinical stage,CEA,and serum albumin were independent prognostic factors affecting overall survival time in patients with stage Ⅲ-Ⅳ NSCLC(P < 0.05).Patients with smoking status at initial diagnosis,pathological type of squamous carcinoma,tumor clinical stage Ⅳ,elevated CEA,and low serum albumin had a high risk of death and a poorer prognosis.Conclusions.(1)The prevalent age of 376 patients with stage Ⅲ-Ⅳ NSCLC in this study was 61-70 years old,and among patients younger than 50 years old,there were more female patients than male.The first symptom was cough and sputum;the location of the tumor was right lung;there were more stage Ⅳ than stage III patients;adenocarcinoma was more common than squamous carcinoma,and organ metastasis was more common in lung,bone and brain.(2)Male,age > 60 years,smoking(especially SI ≥ 400),personal history of respiratory disease,with pleural effusion,clinical stage Ⅳ,combined organ metastasis,pathological type of squamous carcinoma,elevated CEA,high PLR,high NLR,low serum albumin,and no targeted therapy were factors influencing poor prognosis of patients with stage Ⅲ-Ⅳ NSCLC.(3)Smoking status,pathological type,clinical stage,CEA level,and serum albumin were independent influencing factors for overall survival time in stage Ⅲ-Ⅳ patients,and patients with nonsmoking,adenocarcinoma,early stage,normal CEA,and high serum albumin had more survival advantage. |
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