肺结核合并肺癌患者外科手术预后影响因素的多元 Cox 回归模型分析

摘要

目的：采用多元 Cox 回归模型分析肺结核合并肺癌患者外科手术预后的影响因素。方法选择2011年8月—2014年7月长沙市中心医院收治的肺结核合并肺癌患者55例，均行外科手术治疗，收集其临床资料（包括性别、年龄、刺激性咳嗽发生情况、吸烟量、结核部位、手术方式、原结核病灶病变、病理类型及肿瘤 TNM 分期），采用多元 Cox 回归模型筛选肺结核合并肺癌患者外科手术预后的影响因素。结果单因素分析结果显示，不同性别、年龄、结核灶部位、病理类型患者生存时间比较，差异无统计学意义（P ﹥0.05）；有无刺激性咳嗽、不同吸烟量和手术方式、是否为原结核病灶病变及不同肿瘤 TNM 分期患者生存时间比较，差异均有统计学意义（P ﹤0.05）。多元 Cox 回归模型分析结果显示，手术方式〔 OR ＝1.590，95% CI（1.350，2.167）〕、原结核病灶病变〔 OR ＝1.672，95% CI （1.387，1.902）〕及肿瘤 TNM 分期〔OR ＝1.536，95% CI（1.123，1.834）〕是肺结核合并肺癌患者外科手术预后的影响因素（P ﹤0.05）。结论行全肺切除、原结核病灶病变及肿瘤 TNM 分期低的肺结核合并肺癌患者外科手术预后差。%Objective To analyze the influencing factors of prognosis of postoperative pulmonary tuberculosis patients complicated with lung cancer by multivariate Cox regression model. Methods A total of 55 postoperative pulmonary tuberculosis patients complicated with lung cancer were selected in the Central Hospital of Changsha from August 2011 to July 2014,and their clinical data was collected to analyze the influencing factors of prognosis by multivariate Cox regression model,including gender, age,incidence of irritable cough,smoking amount,tuberculosis location,surgical procedure,original tuberculosis location lesion,pathological type and TNM stage. Results Univariate analysis showed that,there was no statistically significant differences of survival time in patients with different gender,age,tuberculosis locations or pathological types( P ﹥ 0. 05), while there were statistically significant differences of survival time in patients with different smoking amounts, surgical procedures,TNM stages,with or without irritable cough,with or without original tuberculosis location lesion( P ﹤ 0. 05). Multivariate Cox regression model analysis showed that,surgical procedure〔OR = 1. 590,95% CI(1. 350,2. 167)〕,original tuberculosis location lesion〔 OR = 1. 672,95% CI( 1. 387,1. 902 )〕 and TNM stage〔 OR = 1. 536,95% CI( 1. 123, 1. 834)〕were influencing factors of prognosis of postoperative pulmonary tuberculosis patients complicated with lung cancer(P﹤ 0. 05). Conclusion Of pulmonary tuberculosis patients complicated with lung cancer,the prognosis of patients undergoing pneumonectomy,with original tuberculosis location lesion and with low TNM stage is poor.