不确定切除对非小细胞肺癌预后的影响  

The impact of uncertainty resection on the prognosis of non-small cell lung cancer

作　　者：张难[1] 张少为[1] 韩晶[2] 王哲[1] 容宇[3] 刘俊峰[1] Zhang Nan;Zhang Shaowei;Han Jing;Wang Zhe;Rong Yu;Liu Junfeng(Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Oncology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Thoracic Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou075061,China)

机构地区：[1]河北医科大学第四医院胸外科,石家庄050011 [2]河北医科大学第四医院肿瘤内科,石家庄050011 [3]河北北方学院附属第一医院胸外科,张家口075061

出　　处：《中华外科杂志》2024年第8期764-770,共7页Chinese Journal of Surgery

摘　　要：目的探讨非小细胞肺癌不确定切除[R(un)]对术后生存的影响。方法本研究为回顾性队列研究。回顾性分析2012年12月至2013年12月在河北医科大学第四医院胸外科接受手术治疗的477例非小细胞肺癌患者的资料。男性302例,女性175例,年龄(59±8)岁(范围:27~79岁)。依据国际肺癌协会颁布的手术切除标准将患者分为完整性切除(R0)组(286例)和R(un)组(191例)。采用χ2检验比较两组间的临床资料,以性别、年龄、吸烟史、辅助治疗、TNM分期、病理学类型及肿瘤部位为协变量进行倾向性评分匹配,采用最近邻法1∶3匹配,卡钳值为0.02。通过Kaplan-Meier法绘制生存曲线,Log-rank检验进行单因素生存分析,Cox比例风险模型分析总体生存的预后因素,对TNM分期、纵隔淋巴结转移状态进行亚组分层分析。结果R(un)组中最高组淋巴结阳性68例,纵隔淋巴结未达到清扫范围129例。倾向性评分匹配后,R0组227例,R(un)组142例。匹配后R0组和R(un)组5年总体生存率分别为64.3%和52.1%(P=0.021),Ⅰ、Ⅱ、Ⅲ期患者的5年总体生存率分别为85.2%、65.9%、34.8%(P<0.01),TNM分期(χ^(2)=46.913,P<0.01)、病理学分型为腺鳞癌(HR=5.970,95%CI:3.117~11.431,P<0.01)及R(un)(HR=1.512,95%CI:1.065~2.147,P=0.021)是总体生存的预后因素。亚组分析结果显示,Ⅲ期患者中,R0组和R(un)组5年总体生存率分别为45.8%和9.5%(P=0.002);纵隔淋巴结转移患者中,R0组和R(un)组5年总体生存率分别为50.6%和7.1%(P<0.01)。结论TNM分期、病理学类型及是否为R(un)是非小细胞肺癌术后总体生存的预后因素。在Ⅰ~Ⅱ期非小细胞肺癌患者中,R(un)不影响术后总体生存;在Ⅲ期及有纵隔淋巴结转移的患者中,R(un)患者的总体生存较R0患者更差。ObjectiveTo explore the impact of uncertain resection on postoperative survival in non-small cell lung cancer.MethodsThis is a retrospective cohort study.A retrospective analysis was conducted on the data of 477 patients with non-small cell lung cancer who underwent lobectomy in the Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University from December 2012 to December 2013.There were 302 males and 175 females,aged(59±8)years(range:27 to 79 years).According to the surgical resection criteria issued by the International Association for the Study of Lung Cancer,the patients were divided into the intact resection group(R0 group,286 cases)and the uncertain resection group(R(un)group,191 cases).Clinical data between the two groups were compared using χ^(2) test,and propensity score matching(PSM)was performed on patients using the R language,with matching variables including gender,age,smoking history,adjuvant therapy,TNM stage,pathological type,and tumor site.The nearest-neighbor method was used for 1∶3 matching and the caliper value was 0.02.The survival curve was plotted using the Kaplan-Meier method and compared using the Log-rank test.The Cox proportional hazards regression model was used to identify risk factors in overall survival(OS).Subgroup analysis was based on TNM staging and mediastinal lymph node metastasis status.ResultsIn the R(un)group,68 patients had positive lymph in the highest group and 129 patients did not undergo complete dissection of the mediastinal lymph nodes.The baseline data for the R0 group and the R(un)group were corrected using PSM,and a total of 369 patients were successfully matched,including 227 cases in the R0 group and 142 cases in the R(un)group.After PSM,the 5-year survival rates of the R0 group and the R(un)group were 64.3%and 52.1%,respectively(P=0.021).The 5-year survival rates of stageⅠ,Ⅱ,andⅢpatients were 85.2%,65.9%,and 34.8%,respectively(P<0.01).TNM stage(χ^(2)=46.913,P<0.01),pathological classification of adenosquamous cell carcinoma(HR=5.9

关 键 词：癌 非小细胞肺 淋巴结切除术 预后 不确定性切除 病理学分型 

分 类 号：R734.2[医药卫生—肿瘤]