慢性阻塞性肺疾病对非小细胞肺癌术后复发风险的影响  

Impact of Chronic Obstructive Pulmonary Disease on Risk of Recurrence in Patients with Resected Non-small Cell Lung Cancer

作　　者：强光亮[1] 余其多[1] 梁朝阳[1] 宋之乙[1] 石彬[1] 郭永庆[1] 刘德若[1] Guangliang QIANG, Qiduo YU, Chaoyang LIANG, Zhiyi SONG, Bin SHI, Yongqing GUO, Deruo LIU(Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, Chin)

机构地区：[1]中日友好医院胸外科,北京100029

出　　处：《中国肺癌杂志》2018年第3期215-220,共6页Chinese Journal of Lung Cancer

摘　　要：背景与目的肺癌和慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)和非小细胞肺癌(non-small cell lung cancer,NSCLC)均是呼吸系统的常见病和多发病,在世界范围内均是高发病率和高死亡率的疾病。本研究旨在探讨COPD的严重程度是否影响NSCLC切除术后的远期生存。方法回顾性分析421例肺叶切除术的NSCLC患者资料,根据慢性阻塞性肺疾病全球倡议(Global Initiative for Chronic Obstructive Lung Disease,GOLD)指南对COPD患者严重程度进行分级,将入组患者分为3组,比较临床病理特征和无复发生存(recurrence-free survival,RFS)的差异。结果合并COPD者共172例,其中轻度124例,中度46例,重度2例。随着COPD严重程度增加,术后复发率增加(P<0.001)。无COPD组、轻度COPD组(GOLD-1)和中重度COPD组(GOLD-2/3)的5年无复发生存率分别为78.1%,70.4%和46.4%,差异有统计学意义(P<0.001)。单因素分析结果显示,年龄、性别、吸烟史、COPD严重程度、肿瘤直径、组织学类型和病理分期是影响患者无复发生存的危险因素。Cox多因素回归分析结果显示,年龄、性别、中重度COPD和病理分期是影响患者预后的独立危险因素。结论合并中重度COPD是影响NSCLC患者术后无复发生存的独立危险因素,可结合患者术前肺功能来判断预后,更准确地预测复发风险,为高危患者制定合理的个体化治疗方案。Background and objective Lung cancer and chronic obstructive pulmonary disease （COPD） are both common diseases in respiratory system and the leading causes of deaths worldwide. The purpose of this study was to determine whether the severity of COPD affects long-term survival in non-small cell lung cancer （NSCLC） patients after surgical resection. Methods A retrospective research was performed on 421 consecutive patients who had undergone lobectomy for NSCLC. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease （GOLD）. Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed. Results A total of 172 patients were diagnosed with COPD, 124 as mild （GOLD-1）, 46 as moderate（GOLD-2）, and 2 as severe （GOLD-3）. The frequencies of recurrence were significantly higher in higher COPD grades group （P〈0.001）. Recurrence-free survival at five years were 78.1%, 70.4%, and 46.4% in Non-COPD, GOLD-1 COPD, and GOLD-2/3 COPD groups, respectively （P〈0.001）. In univariate analysis, age, gender, smoking history, COPD severity, tumor size, histology and pathological stage were associated with recurrence-free survival. Multivariate analyses showed that older age, male, GOLD-2/3 COPD, and advanced stage were independent risk factors associated with recurrence-free survival. Conclusion NSCLC patients with COPD are at higher risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor. The severity of COPD based on pulmonary function test can be a useful indicator to identify patients at high risk for recurrence. Therefore, it can contribute to adequate selection of the appropriate individualized treatment.

关 键 词：肺肿瘤 慢性阻塞性肺疾病 手术 肺功能 预后 

分 类 号：R563.9[医药卫生—呼吸系统] R734.2[医药卫生—内科学]