云南个旧锡矿工人职业相关肺癌病理变化及97例鳞癌治疗与生存

目的 探讨云南个旧锡矿工人职业相关肺癌病理类型变化趋势及鳞癌的治疗与生存.方法 2005年1月至2012年12月符合诊断标准患者210例,分析病理构成比,对97例鳞癌治疗及预后进行分析.采用Kaplan-meier法计算总生存率(OS),Logrank法单因素预后分析,COX风险比例模型多因素预后分析.结果 210例患者鳞状细胞癌、腺癌、小细胞肺癌分别占46.2%、31%、19%.97例鳞癌中,ⅠⅡ期1 a、2 a、3 a OS为83.3%,74.8%,64.8%,ⅢaⅢb期29.8%,6.8%,3.4%,Ⅳ期9.8%,2.4%,0%(P=0.000).多因素分析显示KPS评分、TNM分期及治疗方式是总生存率的独立预后因素.结论 云南个旧锡矿工人职业相关肺鳞癌占比呈下降趋势,腺癌升高.ⅠⅡ期肺鳞癌预后和国内外一般人群相同分期非小细胞肺癌相似,Ⅲ、Ⅳ期比国内外一般人群差,其独立预后因素是KPS评分、TNM分期、治疗方式.

The Pathological Changes of Occupational Lung Cancer in Yunnan Gejiu's Tin Miners and the Therapy and Survival Analysis of 97 Lung Squamous Carcinoma

Objective To explore the incidence trends for different pathological types of occupational lung cancer in tin miners in Gejiu city of Yunnan province and analyze the treatment and efficacy of lung squamous cell carcinoma. Methods A retrospective study was carried out to review the pathological data of 210 patients who diagnosed occupational lung cancer in tin miners at the 3rd People's Hospital of Honghe Autonomous from January2005 to December 2012.The treatment patterns, overall survival(OS) and prognostic factors of 97 patients with squamous cell lung carcinoma were assessed from diagnosis until death or last follow-up. The Kaplan-Meier method was used to evaluate the overall survival. Log-rank test(for univariate prognostic analysis) and Cox regression analysis(for multivariate prognostic analysis) were performed in the 97 squamous cell lung carcinoma patients.Results The percentage distribution of pathological categories of all the 210 occupational lung cancer patients of tin miners was as follows: squamous cell lung carcinoma 46.2%, adenocarcinoma(AC) 31%, small cell lung carcinoma 19%, and the other 3.8%. Of the 97 patients of occupational squamous cell lung carcinoma of tin miners,the 1-, 2-, and 3-year OS rates of TMN stage I-II patients were 83.3%, 74.8%, 64.8%, stage Ⅲa-Ⅲb were29.8%,6.8 %,3.4% and stage IV were 9.8%,2.4%,0%(p=0.000). Multivariate analysis showed that KPS score,TNM stage and treatment patterns were the independent prognostic factors of overall survival in patients with occupational squamous cell lung carcinoma. Conclusions In the occupational lung carcinoma of tin miners in Gejiu, Yunnan before 2005, the proportion of squamous cell carcinoma(SCC) decreased and the proportion of adenocarcinoma corresponding increased. In occupational squamous cell lung carcinoma patients, the prognosis of TMN stage I/II was similar to the patients with NSCLC at home and aboard. While for patients of stage III and IV,the prognosis was worse. The KPS scoring, TNM staging and therapy methods are the independent prognostic factors for occupational squamous cell lung carcinoma patients.