pN2-ⅢA期非小细胞肺癌患者的术后生存状况和预后因素分析  

Survival and Prognostic Factors Analysis of Stage N2 -ⅢA Non - small Cell Lung Cancer Patients Treated with Surgery

作　　者：田翠孟[1] 张旭[1] 夏广荣[1] 徐永祥[1] 刘桂梅[1] Tian Cuimeng;Zhang Xu;Xia Guangrong;Xu Yongxiang;Liu Guimei(Department of Radiotherapy, Beijing Chest Hospital, Capital Medicine University, Beijing 101149, China)

机构地区：[1]首都医科大学附属北京胸科医院放疗科,101149

出　　处：《结核病与胸部肿瘤》2019年第1期56-62,共7页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨pN2-III A期非小细胞肺癌(NSCLC)患者术后的远期生存情况及其影响因素.方法收集2010年10月至2013年6月于北京胸科医院就诊的119例pN2-ⅢA期NSCLC患者的临床及随访资料.采用单因素Kaplan-Meier法和多因素Cox回归模型分析119例接受根治手术患者的总生存期(OS)、无进展生存期(PFS)、肺内PFS及其影响因素.结果119例患者的1、3、5年生存率分别为88.2%.53.8%和35. 7%,中位OS为43个月(95%CI: 31.49?54. 51个月).单因素分析显示N2分类(N2al、N2a2、N2b)、术后辅助化疗、术后辅助放疗均为影响预后的因素,Cox多因素分析显示N2分类和术后辅助放疗为影响OS的独立危险因素,N2a2、N2b及术后未辅助放疗患者较N2al、术后辅助放疗患者的OS缩短,死亡风险倍数分别为2.279、2.841、1.959倍(P<0.05);而N2分类、术后辅助化疗及术后辅助放疗均为影响PFS、肺内PFS的独立危险因素.对N2转移患者进行单站转移N2和多站转移N2分组,结果显示单站转移M患者中术后是否辅助放疗在OS、PFS、肺内PFS的差异均无统计学意义(P >0.05 ),多站转移M患者中术后是否辅助放疗在OS、PFS、肺内PFS的差异均有统计学意义(P<0.05)。结论N2分类为影响pN2 ~ⅢA期NSCLC患者的重要预后因素,术后辅助放化疗能提高局部控制和远期生存,其中术肩辅助放疗使多站转移N2患者明显获益.Objective To investigate the survival and its related factors of the patients with stage N2-ⅢA non-small cell lung cancer (NSCLC) after surgery. Methods From October 2010 to June 2013 in Beijing Chest Hospital, 119 patients with pathological N2-ⅢA NSCLC after resection were enrolled. Kaplan-Meier analysis and Cox multivariate regression analysis were used to evaluate the overall survival( OS), progression-free survival PFS), pulmonary PFS and its related factors. Results Until the end of follow-up, the 1, 3, 5 -year survival rates and median OS were 88.2%、53. 8%、 35. 7% and 43 months ( 95%CI: 31. 49-54. 51 months), respectively. Kaplan-Meier single factor analysis revealed that N2 classification, postoperative adjuvant chemotherapy, postoperative adjuvant radiotherapy(PORT) were the independent factors for OS, PFS and pulmonary PFS. Cox regression analysis revealed that N2 classification and PORT were the independent factors for OS, the OS of N2a2, N2b and no PORT patients was short compared with N2a, and PORT patients, and the risk of death was 2.279, 2.841 and 1.959 times respectively ( P < 0. 05). N2 classification, postoperative adjuvant chemotherapy and PORT were independent factors for PFS and pulmonary PFS. Kaplan-Meier analysis was used to evaluate the OS, PFS, pulmonary PFS with PORT or no PORT. The results showed that there was no significant difference in OS, PFS and pulmonary PFS among patients with single station N2 metastasis (P > 0. 05). While there were significant difference in OS, PFS and pulmonary PFS among patients with multiple station N2 metastasis( P<0. 05). Conclusion N2 classification is the important prognostic factors of stage N2-ⅢA NSCLC patients treated with surgery. Postoperative adjuvant chemotherapy and PORT can improve local control and longterm survival, and PORT is indispensable for multiple station involved N2 .

关 键 词：非小细胞肺癌 pN2-ⅢA期 肺癌根治术 预后分析 

分 类 号：R692.507[医药卫生—泌尿科学]