III期非小细胞肺癌手术是否有价值  

Value of Surgery for Stage IIIa Non-small Cell Lung Cancer

作　　者：刘慧慧[1] 王孟昭[1] 胡克[1] 徐燕[1] 马满姣[1] 钟巍[1] 赵静[1] 李龙芸[1] 王华竹[1] 

机构地区：[1]中国医学科学院北京协和医院,北京100730

出　　处：《中国肺癌杂志》2013年第12期639-645,共7页Chinese Journal of Lung Cancer

摘　　要：背景与目的对于III期非小细胞肺癌(non-smallcelllungcancer,NSCLC),目前普遍倡导手术、化疗、放疗的多学科综合治疗,但许多研究者对是否应该手术提出了质疑。该研究探讨了手术对于III期NSCLC患者的价值。方法回顾性分析2002年3月-2012年10月北京协和医院收治的经病理学确诊的III期NSCLC患者310例。根据最初确诊时是否手术可分为手术组和非手术组。IIIa期根据N分期的不同可分为T4N0/T3-4N1M0期和T1-3N2M0期。采用χ2检验比较计数资料,Kaplan-Meier方法比较总生存期(overall survival,OS)和无进展生存期(progression free survival,PFS),并绘制生存曲线。结果 ECOG评分0分和IIIa期NSCLC患者更倾向于手术治疗。IIIa期手术与非手术组的中位OS分别为38.9个月和21.8个月,中位PFS分别为19.2个月和11.9个月。两组OS的差异有统计学意义(P=0.041),PFS的差异无统计学意义(P=0.209)。IIIa期中的T4N0/T3-4N1M0期手术与非手术组的中位OS分别为48.7个月和20.1个月,中位PFS分别为14.6个月和10.5个月,两组OS和PFS的差异均无统计学意义(P>0.05);T1-3N2M0期手术与非手术组中位OS分别为38.9和30.8月,中位PFS分别为19.8个月和12.7个月,两组OS和PFS的差异亦无统计学意义(P>0.05)。肿瘤最大径和辅助化疗对IIIa-N2期患者的OS和PFS的影响有统计学意义,而肿瘤的病理类型仅影响患者的OS(P<0.05)。结论 ECOG评分0分和IIIa期NSCLC患者更适于手术治疗。手术可延长IIIa期尤其是T4N0/T3-4N1M0期NSCLC患者的OS,但对PFS无改善作用。肿瘤最大径和辅助化疗对IIIa-N2期患者的OS和PFS均有明显影响,而肿瘤的病理类型只影响其OS。Background and objective Nowadays, comprehensive treatment, induding surgery, chemotherapy and radiotherapy is advocated for stageⅢ non-small cell lung cancer （NSCLC）. However, many researchers have questioned the effectiveness of surgery, The aim of this study is to evaluate the effect of surgery for stage Ⅲ NSCLC. Methods Between March 2002 and October 2012, 310 cases that have completed foUowed-up data with stage LII NSCLC were received in the Peking Union Medical College Hospital. They were divided into surgical and non-surgical groups according to whether received sur- gery when diagnosed. In TNM staging, stage Ⅲ NSCLC includes stageⅢa and ILib, and stage Ⅲa NSCLC can be grouped into stage T4N0/T3-4N1M0 and T1-3N2M0 according to different N stages. Analyzed the enumeration data by Chi-Square test. Kaplan-Meier survival method was used to calculate the overall survival （OS） and progression-free survival （PFS）, and to draw the survival curves. A P value less than 0.0S was evaluated as statistically significant. Results Three hundred and ten stage LII NSCLC patients include surgical group 189 cases and non-surgical group 121 cases. One hundred and eighty-eight stage Ⅲa NSCLC patients include surgical group 152 cases and non-surgical group 36 cases. In stage ILia, stage T4N0/T3-4NIM0 had 57 patients with 44 surgical and 13 non-surgical patients, and stage TI-3N2M0 had 131 patients with 108 surgical and 23 non-surgical patients. Thirty-seven out of 121 stage IIIb NSCLC patients received surgery. They had 22 stage T4N2M0 cases and 15 stage T1-4N3M0 cases.The patient whose performance status was 0 and staging was stage LiIa was more inclined to un- dergo surgery. For stage ILia NSCLC patients, the median OS of surgical and non-surgical groups were 38.9 and 21.8 months, and the median PFS of them were 19.2 and 11.9 months respectively.The difference of OS between the two groups was signifi- cant （P=0.041）, but the PFS of them had no significant difference （P=0.209）. For stage T4NO/T3-

关 键 词：肺肿瘤 手术 非手术 影响因素 

分 类 号：R734.2[医药卫生—肿瘤]