检索历史 清除

目的 分析86例非小细胞肺癌患者经手术、化学治疗、放射治疗或者联合治疗后的效果,并探讨相应的临床价值.方法 选取2014年2月至2017年12月运城市中心医院肿瘤科收治的86例非小细胞肺癌(NSCLC)患者,根据治疗方式的不同分为放射治疗组26例、手术组28例、手术+放射治疗组32例.评估经不同方式治疗后患者的近期治疗效果,采用Kaplan-Meier法对患者的生存情况进行计算及统计分析,对三组患者在不同临床分期中的分布进行分层分析,最后观察三种不同的治疗方式给患者带来的并发症情况.结果 放射治疗组在完全缓解、部分缓解、无变化和病情进展中的人数分别为9、11、4、2例;手术组在完全缓解、部分缓解、无变化和病情进展中的人数分别为11、15、0、2例;手术+放射治疗组在完全缓解、部分缓解、无变化和病情进展中的人数分别为23、7、1、1例,三组人数分布比较,差异有统计学意义(χ2=15.759,P=0.015).两组间χ2检验显示,放射治疗组和手术组两组间治疗效果比较,差异无统计学意义(χ2=4.748,P=0.191),手术+放射治疗组与放射治疗组两组间治疗效果比较,差异有统计学意义(χ2=8.057,P=0.045),手术+放射治疗组与手术组两组间治疗效果比较,差异有统计学意义(χ2=8.248,P=0.041).手术+放射治疗组患者的1年、2年及3年的生存率分别为56.3% 、21.9% 、28.6% ,与放射治疗组(100% 、0、0)和手术组(75.0%、17.9%和7.1%)比较,差异有统计学意义(P>0.05).进一步根据患者的临床分期对三组患者的病例分布进行统计分析,观察到放射治疗组在Ⅰ、Ⅱ、Ⅲ及Ⅳ期中的人数为7、5、5、9例;手术组在Ⅰ、Ⅱ、Ⅲ及Ⅳ期中的人数为8、6、6、8例;手术+放射治疗组在Ⅰ、Ⅱ、Ⅲ及Ⅳ期中的人数为1、2、11、18例,三组患者的病例分布比较,差异有统计学意义(χ2=13.993,P=0.030).两组间χ2检验显示,放射治疗组和手术组两组间比较,差异无统计学意义(χ2=0.234,P=0.972),手术+放射治疗组与放射治疗组两组间比较,差异有统计学意义(χ2=10.528,P=0.015),手术+放射治疗组与手术组比较,差异有统计学意义(χ2=12.550,P=0.006).三组患者并发症发生情况显示,放射治疗组26例患者中有15例(57.7% )出现放射性肺炎症状,13例(50.0% )出现放射性食管炎症状,两种并发症均发生的有8例(30.8% );手术组28例患者中有15例(53.6% )出现放射性肺炎症状,12例(42.9% )出现放射性食管炎,两者均出现有7例(25.0% );手术+放射治疗组32例患者中,8例(25.0% )出现放射性肺炎症状,5例(15.6% )出现放射性食管炎症状,2例(6.3% )同时并发放射性肺炎和放射性食管炎.三组患者在放射性肺炎、放射性食管炎及两者均并发情况的比较,差异有统计学意义(χ2=7.700,8.624,6.154;P=0.021,0.013,0.046).进一步分析结果显示,与手术+放射治疗组比较,放射治疗组和手术组的并发症发生率均较高,差异有统计学意义(P<0.05).结论 综合治疗明显优于单项联合治疗,不仅提高了患者的生存率,更降低了治疗后并发症的发生率,预后改善较好,其次提示在不同的临床分期中治疗方式存在差异,临床上应给予重视.

Objective To analyze the effect of surgery,chemotherapy,radiotherapy or combined therapy on 86 patients with non-small cell lung cancer(NSCLC),and to investigate the corresponding clini-cal value. Methods A retrospective study was performed on 86 cases of patients with NSCLC,who were admitted from February 2014 to December 2017. According to the different treatment methods,there were 26 cases in the radiotherapy group,28 cases in the surgical group,and 32 cases in the surgical + radiotherapy group.Kaplan-Meier method was used to calculate and statistically analyze the survival of the pa-tients.Stratified analysis was conducted on the distribution of the three groups of patients in different clini-cal stages.Finally, complications caused by the three different treatment methods were observed. Results In the radiotherapy group, the number of patients in complete remission, partial remission, no change and disease progression was 9,11,4 and 2,respectively.There were 11,15,0 and 2 patients in the surgical group with complete remission, partial remission, no change and disease progression, respective-ly.The number of patients in the surgical + radiotherapy group with complete remission,partial remission, no change and disease progression was 23,7,1 and 1,respectively.The three groups had statistically signifi-cant differences in population distribution(χ2=15.759,P=0.015).The result of chi-square test showed that there was no statistically significant difference between the radiotherapy group and the surgical group (χ2=4.748,P=0.191).There was statistically significant difference in treatment effect between the surgi-cal + radiotherapy group and the radiotherapy group(χ2=8.057,P=0.045).There was statistically sig-nificant difference in treatment effect between the surgical + radiotherapy group and the surgical group (χ2=8.248,P=0.041).The 1-year,2-year and 3-year survival rates of patients in the surgical + radio-therapy group was 56.3% ,21.9% and 28.6% ,respectively,which were statistically significant different from those in the radiotherapy group(100% ,0,0)and the surgical group(75.0% ,17.9% and 7.1% ,P>0.05).According to patients′clinical stage,in period ofⅠ,Ⅱ,ⅢandⅣ,there were 7,5,5,9 cases in the radiotherapy group;8,6,6,8 cases in the surgical group;1,2,11,18 cases in surgical + radiotherapy group (χ2=13.993,P=0.030).Two groups of chi-square test showed that the radiotherapy group and the surgi-cal group had no statistically significant difference(χ2=0.234,P=0.972),the surgical + radiotherapy group and the radiotherapy group had statistically significant difference(χ2=10.528,P=0.015),the surgi-cal + radiotherapy group and the surgical group had no statistically significant difference(χ2=12.550,P=0.006).Complications of the patients in the three groups showed that 15 cases(57.7% )of the 26 patients in the radiotherapy group presented symptoms of radiation pneumonia,13 cases(50.0% ) presented symp-toms of radiation esophageal inflammation,and 8 cases(30.8% )of both complications.There were 15 cases (53.6% )in the surgical group presented symptoms of radiation pneumonia,12 cases(42.9% ) presented symptoms of radiation esophageal inflammation, and 7 cases ( 25.0% ) of both complications.There were 32 cases in the surgical + radiotherapy group,8 cases(25.0% )presented symptoms of radiation pneumoni-a,5 cases(15.6%)presented symptoms of radiation esophageal inflammation,and 2 cases(6.3%)of both complications.Three groups of patients were compared in radiation pneumonia, radiation esophagitis and their combination,and the differences were statistically significant(χ2=7.700,8.624,6.154;P=0.021, 0.013,0.046).Further analysis showed that compared with the surgical + radiotherapy group,the inci-dence of complications was higher in both the radiotherapy group and the surgical group(P<0.05). Con-clusion Comprehensive treatment is significantly better than single treatment,not only in the survival rate, but also in reducing the complications after treatment,the prognosis is better,and then it is suggested that there are differences in treatment methods in different clinical stages, clinically should be given more attention.