国际肿瘤学杂志

国际肿瘤学杂志 ›› 2019, Vol. 46 ›› Issue (8): 460-465.doi: 10.3760/cma.j.issn.1673-422X.2019.08.003

• 论著 • 上一篇    下一篇

2 403例肺癌临床流行病学分析

汪育锦1  黄静宇1  胡卫东1 李胜2  唐政1  杨泽天1  沈小艳1  宋从宽1  李飞3   

  1. 1武汉大学中南医院胸心血管外科 湖北省肿瘤临床研究中心 肿瘤生物学行为湖北省重点实验室  430071； 2武汉大学中南医院生物样本库 湖北省人类遗传资源保藏中心  430071； 3武汉大学中南医院病案室  430071
  • 收稿日期:2018-12-20 修回日期:2019-04-19 出版日期:2019-08-08 发布日期:2019-10-31
  • 通讯作者: 胡卫东 E-mail:huwd@whu.edu.cn
  • 基金资助:

    湖北省卫生和计划生育委员会重点支撑项目（WJ2017Z006）；武汉大学中南医院科技创新培育基金（cxpy2017041）

Clinical epidemiological analysis of 2 403 cases of lung cancer

Wang Yujin1, Huang Jingyu1, Hu Weidong1, Li Sheng2, Tang Zheng1, Yang Zetian1, Shen Xiaoyan1, Song Congkuan1, Li Fei3   

  1. 1Department of Cardiovascular Thoracic Surgery, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center; Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan 430071, China; 2Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Human Genetics Resource Preservation Center of Hubei Province, Wuhan 430071, China; 3Department of Medical Record, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
  • Received:2018-12-20 Revised:2019-04-19 Online:2019-08-08 Published:2019-10-31
  • Contact: Hu Weidong E-mail:huwd@whu.edu.cn
  • Supported by:

    Key Project of Hubei Provincial Health and Family Planning Commission (WJ2017Z006); Science Technology and Innovation Cultivating Fund of Zhongnan Hospital of Wuhan University (cxpy2017041)

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摘要： 目的  回顾性分析2013—2017年武汉大学中南医院2 403例肺癌病例，以初步了解近年来肺癌的流行病学变化趋势。方法  收集2013—2017年5年间武汉大学中南医院诊断为原发性支气管肺癌的住院患者病历资料，对患者的性别、年龄、烟酒史、手术情况、病理类型、临床分期及表皮生长因子受体（EGFR）基因突变情况等临床资料进行统计学分析。结果  共收集肺癌病例2 403例，其中男性1 766例，女性637例。5年间，肺癌患者男女比例差异无统计学意义（χ2=8.481，P=0.075）。有年龄信息的病例共2 398例，＜40岁、40～49岁、50～59岁、60～69岁、70～79岁、≥80岁年龄段的肺癌患者男女比例分别为0.9∶1.0、1.4∶1.0、2.4∶1.0、3.6∶1.0、3.4∶1.0、3.3∶1.0，差异具有统计学意义（χ2=59.004，P＜0.001）。5年间腺癌构成比差异无统计学意义（χ2=2.165，P=0.705）；鳞状细胞癌构成比差异无统计学意义（χ2=4.788，P=0.310）。5年间腺癌在男、女性患者的各类病理类型中分别占43.15%（762/1 766）和81.95%（522/637），差异有统计学意义（P＜0.001）；鳞状细胞癌分别占39.01（689/1 766）%和7.38%（47/637），差异有统计学意义（P＜0.001）。吸烟患者中鳞状细胞癌占比为42.99%（583/1 356），明显高于非吸烟患者的14.61%（153/1 047）；饮酒患者中鳞状细胞癌占比为40.56%（277/683），高于非饮酒患者的26.69%（459/1 720），差异均有统计学意义（均P＜0.001）。手术患者共1 252例，占所统计病例的52.10%（1 252/2 403）；小细胞癌的手术率为21.72%（48/221），非小细胞癌的手术率为55.18%（1 204/2 182）；5年间，患者的手术比例分别为55.11%（221/401）、51.53%（252/489）、58.23%（244/419）、53.18%（276/519）、45.04%（259/575），各年份手术与非手术患者构成比的差异有统计学意义（χ2=19.553，P=0.001）。检测EGFR是否突变的肺癌患者共483例，腺癌患者中EGFR突变率为58.8%（251/427），鳞状细胞癌患者中EGFR突变率为15.6%（5/32）。＜40岁、40～49岁、50～59岁、60～69岁、70～79岁、≥80岁年龄段的肺癌患者中，腺癌占比分别为76.74%（33/43）、62.39%（136/218）、57.73%（381/660）、47.95%（455/949）、52.22%（235/450）、52.56%（41/78），差异具有统计学意义（χ2=33.078，P＜0.001）；各年龄段鳞状细胞癌所占比例分别为9.30%（4/43）、21.56%（47/218）、28.03%（185/660）、34.14%（324/949）、32.44%（146/450）、35.90%（28/78），差异具有统计学意义（χ2=26.977，P＜0.001）。各年份TNM分期构成比差异有统计学意义（χ2=21.003，P=0.034）。结论  5年间，肺癌患者男女比例无明显变化。随着年龄的增长，男女比例呈先升高后下降的趋势。腺癌和鳞状细胞癌的比例在近5年间无明显上升或下降趋势。男性肺癌患者腺癌和鳞状细胞癌均高发，而女性患者以腺癌为主。鳞状细胞癌在吸烟、饮酒患者中高发。鳞状细胞癌的手术率高于腺癌，非小细胞肺癌的手术率高于小细胞肺癌。腺癌EGFR突变率较高。随着年龄的增长，腺癌在所有病理类型中的比例有下降趋势，而鳞状细胞癌有上升的趋势。肺癌患者整体TNM分期有提早趋势，手术率略有下降。

关键词: 肺肿瘤, 流行病学, 病理学

Abstract: Objective  To understand preliminaryly the epidemiological trend of lung cancer in recent years by retrospective analysis of 2 403 cases of lung cancer in Zhongnan Hospital of Wuhan University from 2013 to 2017. Methods  The clinical data of patients with primary bronchogenic cancer diagnosed in Zhongnan Hospital of Wuhan University from 2013 to 2017 were collected. The clinical data such as gender, age, history of tobacco and alcohol, operation, pathological type, clinical stage and epidermal growth factor receptor (EGFR) gene mutation were analyzed statistically. Results  A total of 2 403 cases of lung cancer were collected, including 1 766 males and 637 females. There was no significant difference in gender ratio between male and female in five years (χ2=8.481, P=0.075). There were 2 398 cases with age information, the male-to-female ratios of lung cancer patients aged less than 40, 40-49, 50-59, 60-69, 70-79, 80 and over were 0.9∶1.0, 1.4∶1.0, 2.4∶1.0, 3.6∶1.0, 3.4∶1.0 and 3.3∶1.0 respectively, and the difference was statistically significant (χ2=59.004, P＜0.001). The composition difference of adenocarcinoma was not statistically significant in five years (χ2=2.165, P=0.705). There was no statistically significant difference in the composition ratio of squamous cell carcinoma (χ2=4.788, P=0.310). Adenocarcinoma accounted for 43.15% (762/1 766) and 81.95% (522/637) of the pathological types of male and female patients respectively, and the difference was statistically significant (P＜0.001). Squamous cell carcinoma accounted for 39.01% (689/1 766) and 7.28% (47/637) respectively, and the difference was statistically significant (P＜0.001). The proportion of squamous cell carcinoma in smoking patients was 42.99% (583/1 356), which was significantly higher than that in non-smoking patients (14.61%, 153/1 047); the proportion of squamous cell carcinoma in drinking patients was 40.56% (277/683), which was higher than that in non-drinking patients (26.69%, 459/1 720), and the differences were statistically significant (both P＜0.001). A total of 1 252 patients underwent surgery, accounting for 52.10% (1 252/2 403) of the total cases. The surgical rate of small cell carcinoma was 21.72% (48/221), and that of non-small cell carcinoma was 55.18% (1 204/2 182). In five years, the surgical rates of lung cancer patients were 55.11% (221/401), 51.53% (252/489), 58.23% (244/419), 53.18% (276/519) and 45.04% (259/575) respectively, and there was significant difference in the proportion of surgical and non-surgical patients in each year (χ2=19.553, P=0.001). A total of 483 patients were tested for EGFR mutation, the EGFR mutation rate was 58.8% (251/427) in adenocarcinoma patients and 15.6% (5/32) in squamous cell carcinoma patients. Among lung cancer patients aged less than 40, 40-49, 50-59, 60-69, 70-79, 80 and over, the proportions of adenocarcinoma were 76.74% (33/43), 62.39% (136/218), 57.73% (381/660), 47.95% (455/949), 52.22% (235/450) and 52.56% (41/78) respectively, and the difference was statistically significant (χ2=33.078, P＜0.001); the proportions of squamous cell carcinoma were 9.30% (4/43), 21.56% (47/218), 28.03% (185/660), 34.14% (324/949), 32.44% (146/450) and 35.90% (28/78) respectively, and the difference was statistically significant (χ2=26.977, P＜0.001). The difference of composition ratio of TNM staging was statistically significant in five years (χ2=21.003, P=0.034). ConclusionThere has been no significant change of male-to-female ratio in patients with lung cancer in the past five years. With the increase of age, the male-to-female ratio increases first and then decreases. The proportion of adenocarcinoma and squamous cell carcinoma has not increased or decreased significantly in the past five years. Adenocarcinoma and squamous cell carcinoma are both common in male lung cancer patients, while the pathological type of female patients is mainly adenocarcinoma. Squamous cell carcinoma is highly prevalent in smokers and drinkers. The surgical rate of squamous cell carcinoma is higher than that of adenocarcinoma, and the surgical rate of non-small cell lung cancer is higher than that of small cell lung cancer. The EGFR mutation rate is higher in adenocarcinoma. With the increase of age, the proportion of adenocarcinoma in all pathological types tends to decrease, while that of squamous cell carcinoma tends to increase. The patients′ TNM staging has a downward trend, and the operation rate decreases slightly.

Key words: Lung neoplasms, Epidemiology, Pathology