淋巴结降期对ⅢA～N_2期非小细胞肺癌患者术后远期疗效的影响  

The effect of nodal downstage on long- term outcome for patients of non-small-cell lung cancer with ⅢA-N_2 stage

作　　者：王大权[1] 庞青松[1] 章文成[1] 赵路军[1] 徐利明[1] 陈曦[1] 陈秀丽[1] 刘宁波[1] 王平[1] 

机构地区：[1]天津医科大学肿瘤医院放疗科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室,天津市300060

出　　处：《中国肿瘤临床》2016年第2期81-85,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:观察ⅢA^N_2期非小细胞肺癌(NSCLC)诱导化疗加手术患者的术后复发及生存情况,分析淋巴结降期对预后的影响,探索术后放疗的必要性。方法:回顾性选取天津医科大学肿瘤医院2009年1月至2014年6月116例接受诱导化疗加手术的ⅢA^N_2期NSCLC患者116例,全组均为R0切除。Kaplan-Meier法计算局部无复发生存期(local-recurrence free survival,LRFS)、无远处转移生存期(distant-metastasis free survival,DMFS)和生存期(overall survival,OS),Log-rank法比较组间差异,Cox模型多因素预后分析。结果:全组中位随访时间24.42个月。pN_0、pN_1、pN_2期患者分别为40例(34.5%)、16例(13.8%)和60例(51.7%),3年复发率分别为27.5%、56.2%和51.7%。77例患者接受了辅助化疗,其中pN_0、pN_1、pN_2患者3年复发率分别为26.9%、58.3%和46.2%。多因素分析中,pN_0是影响LRFS的因素。pN_1组的LRFS短于pN_0组(P=0.048),pN_1组和pN_2组的LRFS差异无统计学意义(P=0.314)。全组5年生存率为46.6%,多因素分析显示pT_1、pN_(0~1)、诱导化疗疗效是影响OS的因素。pN_2组的OS短于pN_1组和pN_0组(P<0.05),pN_1组和pN_0组的OS差异无统计学意义(P=0.412)。结论:淋巴结降期虽然是ⅢA^N_2期NSCLC诱导化疗加手术患者的良好预后因素,但是淋巴结降期的pN_0和pN_1患者,即使接受了辅助化疗,仍有较高复发风险,有必要探索诱导化疗+手术+术后放疗的新模式。Objective：To observe the locoregional recurrence and survival of stage ⅢA-N2 non-small cell lung cancer （NSCLC） after in-duction chemotherapy and surgery, to analyze the prognosis influenced by nodal downstaging, and to explore the necessity for postop-erative radiotherapy. Methods：A total of 116 cases of stage ⅢA-N2 NSCLC were treated with induction chemotherapy and surgery be -tween January 2009and June 2014. These cases underwent R0 resection. Kaplan-Meier method was employed to calculate the local recurrence-free survival （LRFS）, distant metastasis-free survival （DMFS）, and overall survival （OS） of the patients. Log rank test was con -ducted to compare the differences between groups. Cox models were used to perform multivariate analysis. Results：The median fol-low- up of the patients was 24. 42months. The numbers of patients with pN0, pN1, and pN2 were40（34. 5% ）, 16（13. 8% ）, and 60 （51. 7%）, respectively. The3-year local recurrence rates of patients with pN0, pN1, and pN2 were27. 5%, 56. 2%, and 51. 7%, respectively. In the group treated with adjuvant chemotherapy, the 3- year local- recurrence rates of patients with pN 0, pN1, and pN2 were26. 9% ,58. 3% , and 46. 2% , respectively. Multivariate analysis revealed that the significant predictor of LRFS was pN 0 during the surgery. The LRFS of patients with pN0 was greater than that of the patients with pN1 （P=0. 048 ）. The LRFS of patients with pN 1 was not significantly associated with that of patients with pN2 （P=0. 314 ）. The 5-year OS rate of the groups was 46. 6%. The multivariate analysis also demon strated that pT1, pN0- 1, and induction chemotherapy effects were associated with OS. The patients with pN2 yielded a poorer OS than those with pN 0 and pN 1 （P〈0. 05）. The patients with pN0 did not significantly differ from those with pN1 in terms of OS （ P=0. 412 ）. Conclu -sion： Although the occurrence of pathologic downstaging is a well-known positive prognostic indicator after stageⅢ-N 2 NSCLC

关 键 词：非小细胞肺癌 诱导化疗 ⅢA期 降期 局部复发 

分 类 号：R734.2[医药卫生—肿瘤]