Ⅰ期非小细胞肺癌的诊断与外科治疗

Diagnosis and surgical treatment for stage Ⅰ non-small-cell lung cancer

目的 探讨Ⅰ期非小细胞肺癌 (NSCLC)患者的诊断与治疗。方法 Ⅰ期 (T1N0M0和T2N0M0 )NSCLC患者 2 74例 ,均行手术治疗。术后随访满 5年 ,对随访资料进行生存分析。结果 2 74例中 ,通过体检发现 96例 ,有 81例行痰液脱落细胞学检查 ,查出癌细胞者 33例 ,阳性检出率为4 0 .7%。全组肺叶切除 2 5 7例 ,袖状切除 3例 ,全肺切除 1例 ,楔形切除 9例 ,肺段切除 4例。无围手术期死亡。Ⅰ期NSCLC患者的 1,3,5年生存率分别为 92 .9%、79.6 %和 6 6 .1%。行肺叶切除患者的1,3,5年生存率分别为 94 .1%、79.3%和 6 7.5 % ;楔形切除和肺段切除患者的 1,3,5年生存率分别为76 .5 %、5 0 .0 %和 38.3% (P <0 .0 5 )。结论 定期体检对Ⅰ期肺癌的早期发现与诊断尤为重要 ,痰液脱落细胞学检查应作为Ⅰ期肺癌的常规检查 ,低剂量螺旋CT在早期肺癌的检出及诊断方面具有优越性。外科肺叶切除加纵隔淋巴结清扫是早期肺癌的首选治疗方案。

Objective To evaluate the results of surgery and the diagnosis of stage Ⅰ non small cell lung cancer (NSCLC). Methods The survival of 274 stage Ⅰ NSCLC patients who underwent surgery from 1991 to 1998 were statistically analyzed by the Kaplan Meier method. Comparison of the differences in survival rates among groups were made according to the Logrank test. The follow up time was at least 5 years with a follow up rate of 97.8%. Results The overall 1 , 3 , 5 year survival rates for patients with pathologic stage Ⅰ lesion were 92.9% , 79.6% and 66.1%. The 5 year survival rates for patients with squamous cell carcinoma, adenocarcinoma, adenosquamous and alveolar cell carcinoma were 73.3%,55.3%,52.2%, 71.7%, respectively. The 1 , 3 , 5 year survival rates for T1N0 were 95.0%, 83.2%, 74.3% whereas those of T2N0 lung lesions were 90.8%, 75.9%, 59.9%( P <0.05). The 1 , 3 , 5 year survival rates of regular lobectomy were 94.1%, 79.3%, 67.5% and of conservative resection (segmentectomy and wedge resection) were 76.5%,50.0%,38.3%( P <0.05). There was no perioperative mortality. The postoperative complications were: intrathoracic hemorrhage(2 patients, successfully treated by second thoracotomy) and chylothorax(1 patient, healed after conservative treatment). Conclusion The 5 year survival rate of pathologic stage Ⅰ non small cell lung cancer is 66.1%.The outcome of patients with squamous cell carcinoma (73.3%) is similar to that of alveolar cell carcinoma (71.7%) which, however, is better than that of adenocarcinoma(55.3%) or adenosquamouscarcinoma (52.5%). The overwhelming superiority in result of JP2 ⅠA JP (T1N0) lesion (74.3%) over the JP2 ⅠB JP (T2N0) disease(59.9%) is quite impressive. Regular lobectomy plus radical mediastinal lymph node dissection is the appropriate management for stage Ⅰ non small cell lung cancer.