基于416例I期NSCLC肺叶切除术后随访结果探讨早期NSCLC术后随访策略  

Exploration of Postoperative Follow-up Strategies for Early Staged NSCLC Patients on the Basis of Follow-up Result of 416 Stage I NSCLC Patients after Lobectomy

作　　者：戴亮[1] 闫万璞[1] 康晓征[1] 付浩[1] 杨永波[1] 周海涛 梁震[1] 熊宏超[1] 林瑶[1] 陈克能[1] Liang DAI, Wanpu YAN, Xiaozheng KANG, Hao FU, Yongbo YANG, Haitao ZHOU, Zhen LIANG, Hongchao XIONG, Yao LIN, Keneng CHEN(Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）, the First Department of Thoracic Surgery, Peking University Cancer Hospital and Instituter Peking University School of Oncology, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨恶性肿瘤发病机制及转化研究教育部重点实验室,胸外一科,北京100142

出　　处：《中国肺癌杂志》2018年第3期199-203,共5页Chinese Journal of Lung Cancer

基　　金：本研究受北京大学肿瘤医院院内基金(No.2014-咱主4)、国家自然科学基金创新研究群体科学基金(No.IRT13003)、国家高技术研究发展863计划(No.2015AA020403)和北京市医院管理局临床医学发展专项经费(No.ZYLX201509)资助

摘　　要：背景与目的目前国际上对于早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的随访策略(随访间隔时间和随访内容)并未达成共识,相关的临床证据也十分有限。本研究通过I期NSCLC的随访结果,总结其复发转移的部位及时间,为制定该类患者的随访间隔时间和内容提供参考。方法回顾性分析我科肺癌前瞻性数据库中2000年1月-2013年10月单一医生组连续行解剖性肺叶切除手术的416例I期NSCLC患者,根据复发转移部位及时间,探讨该类患者的长期随访间隔时间和内容。结果全组患者5年无疾病生存率(disease free survival,DFS)与总生存率(overall survival,OS)分别为82.4%和85.4%;随访期间出现复发转移者共76例(18.3%),复发转移部位中常见者依次为肺转移21例(5.0%)、脑转移20例(4.8%)、骨转移12例(2.9%)和纵隔淋巴结转移12例(2.9%)。影响复发转移的因素中,p T2a者复发转移率高于p T1者(P=0.006),5年DFS分别为73.8%和87.6%(P=0.002),5年OS分别为77.7%和90.3%(P=0.011)。结论 I期NSCLC解剖性肺叶切除术后复发转移以肺、脑、骨及纵隔淋巴结最常见,2年内与3年-5年复发转移风险相当,可以根据T分期调整2年内随访次数及随访内容。Background and objective Currently, there is no consensus on the follow-up strategy （follow-up time interval and content） of non-small cell lung cancer （NSCLC） in the world, and the relevant clinical evidence is also very limited. In this study, we aimed to summarize the recurrence/metastasis sites and timings of stage Ⅰ NSCLC patients based on their follow-up data, aiming to provide a basis of follow-up time interval and content for this group of patients. Methods We retrospectively analyzed the 416 stage I NSCLC patients that underwent continuous anatomic lobectomy between Jan. 2000 to Oct. 2013 in our prospective lung cancer database. According to the recurrence/metastasis sites and timings, the long term follow-up time interval and content were explored. Results The 5-yr disease free survival （DFS） and overall survival （OS） in the whole group were 82.4% and 85.4%, respectively. There were 76 cases （18.3%） had recurrence/metastasis during follow-up, among which the most frequent site was pulmonary metastasis （21 cases, 5.0%）, followed by brain metastasis （20 cases, 4.8%）, bone metastasis （12 cases, 2.9%）, and mediastinal lymph node metastasis （12 cases, 2.9%）. Among the factors that could influence recurrence/metastasis, patients with pT2a suffered from a higher recurrence/metastasis rate compared to patients with pT1 （P=0.006）, with 5-yr DFS being 73.8% and 87.3%, respectively （P=0.002）, and the 5-yr OS being 77.7% and 90.3%, respectively （P=0.011）. Conclusion The commonest recurrence/metastasis sites of stage I NSCLC after anatomic lobectomy are lung, brain and mediastinal lymph nodes, the risk of recurrence/metastasis within 2 years were equal to that between 3 years and 5 years. The follow-up frequencies and content within 2 years could be adjusted according to T stages.

关 键 词：肺肿瘤 肺叶切除术 预后 随访 

分 类 号：R734.2[医药卫生—肿瘤]