National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Affiliated Hospital of Guizhou Medical University, Guizhou Province Tumor Hospital, Guiyang, P.R. China.
Cancer Med. 2019 Jul;8(8):4055-4069. doi: 10.1002/cam4.2256. Epub 2019 May 31.
Most lung cancer patients are diagnosed after the onset of symptoms. However, whether the symptoms of lung cancer were independently associated with the diagnosis of lung cancer is unknown, especially in the Chinese population.
We conducted a 10 years (2005-2014) nationwide multicenter retrospective clinical epidemiology study of lung cancer patients diagnosed in China. As such, this study focused on nonsmall cell lung cancer (NSCLC). We calculated the odds ratios (ORs) for variables associated with the symptoms and physical signs using multivariate unconditional logistic regressions.
A total of 7184 lung cancer patients were surveyed; finally, 6398 NSCLC patients with available information about their symptoms and physical signs were included in this analysis. The most common initial symptom and physical sign was chronic cough (4156, 65.0%), followed by sputum with blood (2110, 33.0%), chest pain (1146, 17.9%), shortness of breath (1090, 17.0%), neck and supraclavicular lymphadenectasis (629, 9.8%), weight loss (529, 8.3%), metastases pain (378, 5.9%), fatigue (307, 4.8%), fever (272, 4.3%), and dyspnea (270, 4.2%). Patients with squamous carcinoma and stage III disease were more likely to present with chronic cough (P < 0.0001) and sputum with blood (P < 0.0001) than patients with other pathological types and clinical stages, respectively. Metastases pain (P < 0.0001) and neck and supraclavicular lymphadenectasis (P = 0.0006) were more likely to occur in patients with nonsquamous carcinoma than in patients with other carcinomas. Additionally, patients with stage IV disease had a higher percentage of chest pain, shortness of breath, dyspnea, weight loss, and fatigue than patients with other stages of disease. In multivariable logistic analyses, compared with patients with adenocarcinoma, patients with squamous carcinoma were more likely to experience symptoms (OR = 2.885, 95% confidence interval [CI] 2.477-3.359) but were less likely to present physical signs (OR = 0.844, 95% CI 0.721-0.989). The odds of having both symptoms and physical signs were higher in patients with late-stage disease than in those with early-stage disease (P < 0.0001).
The symptoms and physical signs of lung cancer were associated with the stage and pathological diagnosis of NSCLC. Patients with squamous carcinoma were more likely to develop symptoms, but not signs, than patients with adenocarcinoma. The more advanced the stage at diagnosis, the more likely that symptoms or physical signs are to develop. Further prospective cohort studies are needed to explore these results.
大多数肺癌患者在出现症状后才被诊断出来。然而，肺癌的症状是否与肺癌的诊断独立相关尚不清楚，尤其是在中国人群中。
我们在中国进行了一项为期 10 年（2005-2014 年）的全国多中心回顾性临床流行病学研究，专门针对非小细胞肺癌（NSCLC）。我们使用多变量非条件逻辑回归计算与症状和体征相关的变量的比值比（OR）。
共调查了 7184 例肺癌患者，最终纳入了 6398 例有症状和体征信息的 NSCLC 患者进行分析。最常见的初始症状和体征是慢性咳嗽（4156 例，65.0%），其次是痰中带血（2110 例，33.0%）、胸痛（1146 例，17.9%）、呼吸困难（1090 例，17.0%）、颈和锁骨上淋巴结肿大（629 例，9.8%）、体重减轻（529 例，8.3%）、转移痛（378 例，5.9%）、乏力（307 例，4.8%）、发热（272 例，4.3%）和呼吸困难（270 例，4.2%）。鳞状细胞癌和 III 期疾病患者更有可能出现慢性咳嗽（P<0.0001）和痰中带血（P<0.0001），而其他病理类型和临床分期的患者则较少出现这些症状。转移痛（P<0.0001）和颈和锁骨上淋巴结肿大（P=0.0006）在非鳞状细胞癌患者中更常见。此外，IV 期疾病患者出现胸痛、呼吸困难、呼吸困难、体重减轻和乏力的比例高于其他疾病阶段的患者。多变量逻辑分析显示，与腺癌患者相比，鳞状细胞癌患者更有可能出现症状（OR=2.885，95%置信区间[CI]2.477-3.359），但出现体征的可能性较小（OR=0.844，95%CI 0.721-0.989）。与早期疾病患者相比，晚期疾病患者出现症状和体征的几率更高（P<0.0001）。
肺癌的症状和体征与 NSCLC 的分期和病理诊断有关。与腺癌患者相比，鳞状细胞癌患者更有可能出现症状而不是体征。诊断时的分期越晚，出现症状或体征的可能性就越大。需要进一步的前瞻性队列研究来探讨这些结果。
