通过生存分析评价纵隔镜检查在非小细胞肺癌术前纵隔淋巴结分期中的作用  

Value of mediastinoscopy in preoperative staging of non-small cell lung cancer --based on survival analysis

作　　者：谢绚[1] 王欣[1] 郑列[2] 张仕义[4] 苏晓东[1] 余辉[1] 李涌[1] 周佳亮[1] 凌莉[3] 戎铁华[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心胸科,广州510060 [2]华南肿瘤学国家重点实验室中山大学肿瘤防治中心影像科,广州510060 [3]中山大学公共卫生学院 [4]汕头市中心医院肿瘤外科

出　　处：《中华肿瘤杂志》2009年第12期929-932,共4页Chinese Journal of Oncology

基　　金：基金项目：广东省科技计划项目（2004830301008）

摘　　要：目的通过生存分析评价纵隔镜检查在评估非小细胞肺癌（NSCLC）术前纵隔淋巴结状态中的作用。方法对152例可手术NSCLC患者术前行CT和纵隔镜检查，根据纵隔镜检查结果选择不同的方案进行治疗，并进行长期随访。纵隔淋巴结分期按最终病理结果分为pN0、pN1、pN2和pN3，按CT检查分为cN0～1和cN2～3，按纵隔镜检查分为mN0～1、mN2和mN3。结果pN0组、pN1组、pN2组和pN3组的5年生存率分别为61．7％、75．0％、32．4％和16．1％，pN0组、pN1组的生存率与pN2组、pN3组相比均显著升高（均P〈0．05）。cN0—1组与cN2～3组之间的生存率差异无统计学意义（P=0．670）。mN0～1组与mN2组、mN3组的生存率差异均有统计学意义（均P〈0．05）。结论开胸手术前行纵隔镜检查能较好地判断NSCLC患者的纵隔淋巴结转移情况，预测患者的预后。Objective To evaluate the value of mediastinoscopy in preoperative staging of non-small cell lung cancer （NSCLC） based on survival analysis. Methods 152 cases of potentially operable NSCLC were enrolled in this study. All cases underwent CT scan and mediastinoscopy for assessment of the mediastinal lymph node status before initial treatment. The definitive treatment was decided on the basis of mediastinoscopy and the survival rate was analyzed with a median follow-up of 30.5 months. Survival analysis was conducted by comparing the lymph node status which was determined by final pathology （groups pN0, pN1, pN2, pN3）, CT scan （group cN0-1, cN2-3） and mediastinoscopy （group mN0-1, mN2, mN3）. Results The 5-year survival rates in group pN0, pN1, pN2 and pN3 were 61.7% , 75.0% , 32.4% and 16. 1% , respectively. Both groups pN0 and pN1 had significantly higher survival rates than those in groups pN2 and pN3 （ P 〈 O. 05 ）. There were not significant differences between survival rates in groups cN0-1 and cN2-3 （P = O. 670） , while the survival rate in group mNO-1 was significantly higher than that in groups mN2 and mN3 （ P 〈 0.05 ）. Conclusion Mediastinoscopy is of great value in preoperative staging of NSCLC. Not only does it detect lymph node metastasis more precisely but also better predict the prognosis than CT scan.

关 键 词：癌 非小细胞肺 纵隔镜检查 淋巴结转移 生存分析 

分 类 号：R686[医药卫生—骨科学]