【摘要】 目的为改善我国肺癌防治水平的基础数据缺乏,本研究评估了辽宁省城市社区2000年不同临床分期和不同治疗方式肺癌患者的5年生存率,为评估肺癌防治水平的进展提供基础数据。方法随机选取2000-01-01-2000-12-31沈阳、鞍山和本溪3市肿瘤发病数据库中肺癌患者561例,进行被动结合主动随访,应用寿命表法计算观察生存率(observed survival rate,OSR)和中位生存期(median survival time,T50),采用EdererⅡ方法(Ederer and Heise,1959)计算期望生存率(expected survival rate,ESR)和相对生存率(relative survival rate,RSR),采用Brenner and colleagues(2004)方法计算年龄标化相对生存率(age-standardized relative survival,ASRS)。结果 502例纳入分析的肺癌患者中,Ⅰ～Ⅳ期诊断比例分别为13.3%、5.4%、19.3%和34.3%,Ⅰ～Ⅳ期及全部患者的手术比例分别为49.3%、40.7%、30.9%、11.6%和20.7%。肺癌患者的5年OSR、RSR和T50分别为16.1%、19.5%和11.0个月,其中Ⅰ期(43.3%、51.5%、49.2个月)显著高于Ⅱ期(18.5%、22.6%、11.6个月)、Ⅲ期(10.3%、12.2%、13.1个月)和Ⅳ期(6.4%、7.6%、8.1个月),zOSR=2.581、4.853、5.804,zRSR=2.486、4.865、5.837,χ2T50=11.041、31.578、73.446,均P<0.05。Ⅰ期手术患者的5年OSR、RSR、T50(60.6%、67.9%、>72.0个月)显著高于Ⅰ期非手术患者(26.5%、33.5%、24.0个月),z=2.999、2.544,χ2=9.385,均P<0.05,Ⅱ～Ⅳ期的手术与非手术患者的5年生存率差异无统计学意义,zOSR=0.037、0.898、0.307,zRSR=0.210、1.048、0.402,均P>0.05。多因素Cox模型分析显示,诊断分期(HR=1.506,95%CI:1.345～1.688)、治疗方式(HR=0.752,95%CI:0.567～0.997)和年龄(HR=1.014,95%CI:1.004～1.024)是肺癌生存率的主要影响因素。结论提高社区肺癌早期筛查率和各级医院的肺癌规范化治疗水平将有助于提升辽宁省肺癌患者的5年生存率。更多还原

【Abstract】 OBJECTIVE At present,the basic data for assessing the level of lung cancer prevention and treatment in China is lacking,this study evaluated the 5-year survival rate of lung cancer patients with different clinical stages and different treatments in urban communities of Liaoning Province in 2000.METHODS From January 1,2000 to December 31,2000,561 patients with lung cancer in Shenyang,Anshan and Benxi were randomly sampled in the tumor database,and passive combined with active follow-up was performed,the observed survival rate(OSR)and median survival time(T50)were calculated by using the Life table method,and the EdererⅡmethod(Ederer and Heise,1959)was used to calculate the expected survival rate(ESR),Brenner and colleagues(2004)method was used to calculate the age-standardized relative survival(ASRS).RESULTS Of the 502 patients included in the analysis,the proportion ofⅠ-Ⅳ was 13.3%,5.4%,19.3% and 34.3%,and the operation proportion ofⅠ-Ⅳ and all patients were 49.3%,40.7%,30.9%,11.6% and20.7%,respectively.The 5-year OSR,RSR and T50 of patients with lung cancer were 16.1%,19.5%and 11.0 months respectively,theⅠstage(43.3%,51.5%,49.2 months)was significantly higher than the Ⅱ stage(18.5%,22.6%,11.6 months),Ⅲstage(10.3%,12.2%,13.1 months)and Ⅳ stage(6.4%、7.6%、8.1 months),zOSR =2.581、4.853、5.804,zRSR=2.486,4.865,5.837,χ~2 T50=11.041,31.578,73.446,all P<0.05.The 5-year OSR,RSR,T50(60.6%,67.9%and>72.0 months)of the patients withⅠstage operation were significantly higher than those in theⅠstage non-operation(26.5%,33.5%,24.0 months),z=2.999,2.544,χ~2=9.385,all P<0.05,and there was no significant difference in the 5-year survival rate between the operation of theⅡ-Ⅳ stage and the non-operation patients,zOSR =0.037,0.898,0.307,zRSR=0.210,1.048,0.402,all P>0.05,Multivariate Cox model analysis showed that diagnostic staging(HR=1.506,95%CI:1.345-1.688),therapeutic modalities(HR=0.752,95%CI:0.567-0.997)and age(HR=1.014,95%CI:1.004-1.024)were main factors influencing the survival of lung cancer.CONCLUSION Increasing the early screening rate of lung cancer in community and the standardized treatment level of lung cancer in hospitals at all levels will help to improve the 5-year survival rate of lung cancer patients in Liaoning Province.更多还原