ⅢA-N2期非小细胞肺癌切除术后影响预后的因素分析  

A clinical and prognostic retrospective analysis of Ⅲ A-N2 non-small cell lung cancer

作　　者：张连民[1] 刘喜增[2] 张真发[1] 王长利[1] 朱建权[1] 岳东升[1] 

机构地区：[1]天津市肿瘤防治重点实验室天津医科大学附属肿瘤医院肺部肿瘤科,300060 [2]天津市人民医院影像科

出　　处：《中华外科杂志》2010年第9期690-693,共4页Chinese Journal of Surgery

摘　　要：目的 分析ⅢA-N2期非小细胞肺癌患者的临床情况和影响预后的相关因素,探讨手术及辅助治疗对预后的影响.方法 回顾性分析2000年1月至2005年12月经手术治疗的657例ⅢA-N2期非小细胞肺癌患者的临床资料,应用Kaplan-Meier法进行生存分析.单因素分析各变量与预后的关系采用Log-rank检验,多因素分析采用Cox模型.结果 术后全组患者的l、3和5年累计生存率分别为64.4%、26.0%和17.9%,中位生存期18个月.单因素分析中,影响生存期的不利因素为：肿瘤最大径〉3 cm,高T分期,N2淋巴结无跳跃转移,纵隔淋巴结阳性数〉4个,隆突下淋巴结阳性,治疗方式（单纯手术预后差,患者术后联合放化疗优于术后单纯化疗）,术后未放疗、化疗,化疗周期小于4个.多因素分析显示,肿瘤直径（P=0.001）,隆突下淋巴结阳性（P=0.019）,纵隔淋巴结转移个数（P=0.006）,术后化疗周期（P=0.007）,术后放疗（P=0.055）和术后放化疗（P=0.026）对预后有明显影响.结论 ⅢA-N2期非小细胞肺癌患者5年生存率低,肿瘤直径、隆突下淋巴结阳性、纵隔淋巴结转移个数、术后化疗周期、术后联合放化疗是影响预后的独立因素.术后单站和多站纵隔淋巴结转移的预后相似,影响预后的主要是纵隔淋巴结的阳性个数,术后联合放化疗优于术后单纯化疗.Objective To analyze the clinical conditions of postoperative patients with Ⅲ A-N2 non-small cell lung cancer （NSCLC） and the prognostic factors related with survival of NSCLC, and to investigate the influence of operation and therapy on prognosis. Methods Clinical data of 657 inpatient cases with Ⅲ A-N2 NSCLC admitted from January 2000 to December 2005 was retrospectively reviewed. The Kaplan-Meier method was used for survival analysis. The Log-rank law was applied to analyze the relationship between the variables and the prognosis in monovariate analysis, while Cox proportional hazard regression model was used to make multivariate analysis. Results The 1-, 3-and 5-year accumulative survival rates of the operative patience were 64.4%, 26.0% and 17.9%, respectively. The median survival time was 18 months. In monovariate analysis, the main unfavorable factors that affect life span involve were the diameter of tumor, T stage, skip metastasis of N2 lymph node, the number of metastatic lymph nodes, the metastasis of subcarinal lymph nodes, adjuvant chemotherapy, the cycle of adjuvant chemotherapy, postoperative radiotherapy, and the modality of therapy （the effect of naive surgery was disappointed, while the prognosis of the patients with adjuvant ehemoradiotherapy was better than those with chemotherapy alone）. A multivariate analysis using Cox regression identified 5 factors of prognosis： the diameter of tumor （P = 0. 001 ）, the metastasis of subcarinal lymph nodes （ P = 0. 019）, the number of metastatic lymph nodes （ P = 0. 006）, the cycle of adjuvant chemotherapy （ P = 0. 007 ）, postoperative radiotherapy （ P = 0. 055 ）, and adjuvant ehemoradiotherapy （P = 0. 026）. Conclusions The 5-year survival rate of the patients with Ⅲ A-N2 Non-small cell lung cancer is poor. Tumor size, the metastasis of subcarinal lymph nodes, the number of metastatic LNs, the cycle of adjuvant chemotherapy, and postoperative radiotherapy have an effect on theprognosis. The prognosis of postoperative

关 键 词：癌 非小细胞肺 因素分析 统计学 淋巴转移 肿瘤辅助治疗 

分 类 号：R734.2[医药卫生—肿瘤]