北京协和医院外科治疗肺癌生存率变化分析

The study on improvement of survival for lung cancer surgically intervened in PUMC Hospital

背景与目的肺癌是目前癌症死亡的首要原因.有报道肺癌治疗效果有显著提高,但外科在其中的作用仍有争议.本研究拟探讨北京协和医院胸外科近15年外科治疗肺癌生存率变化的原因.方法回顾性分析1989年1月到2003年12月外科治疗肺癌1574例生存结果,按时间顺序分为两组,比较A组(1999～2003年)和B组(1989～1998年)生存率变化.结果 A组和B组并发症分别为11.2%和19.2%,死亡率分别为1.06%和1.93%,差异有显著性(P<0.01).A组和B组3年生存率分别为56.07%和42.35%,5年生存率分别为38.99%和28.46%,差异有显著性(P<0.05).A组Ⅰ期、Ⅱ期、ⅢA期生存率较B组提高并有显著性差异,而ⅢB期、Ⅳ期生存率无显著性差异.肺叶切除生存率提高明显,而开胸探查、局部肺切除、全肺切除及支气管袖状切除生存率差别不大.结论肺叶切除加系统性淋巴结清扫是支气管肺癌手术治疗的标准方式;肿瘤切除后辅以铂类/第三代化疗药物综合治疗模式,初步证实能提高远期生存率.

Background and objective Lung cancer is still the most common cause of cancer death. Although it is reported that the 5-year survival rate for lung cancer has been greatly increased, surgical results are controversial. The aim of this study is to investigate and evaluate the improvement of survival of lung cancer surgically intervened in PUMC hospital during the last 15 years. Methods From January 1989 to December 2003, 1574 cases of lung cancer underwent surgical treatment and obtained follow-up. The results were retrospectively a- nalysed . All cases in this series were divided into two groups according to time, group A (1999--2003) and group B (1989--1998), and the differences of survival rate between group A and group B were compared. Results The morbidity and mortality of group A decreased significantly when compared to group B (11.2% vs 19.2%, 1.06% vs 1.93%, respectively, P<0.01). However, the 3- and 5-year survival rates had been obviously raised from 42.35% to 56.07%, and from 28.46% to 38.99%, respectively (P< 0.05 ). A significant improvement in survival was observed in patients with stageⅠ, stage Ⅱ and stage ⅢA, but not in stage ⅢB and stage Ⅳ. Also, the patients with lobectomy had better results but those with exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection did not show better results. Conclusion Lobectomy associated with systematic dissection of mediastinal lymph nodes has become the standard mode for the resectable lung cancer. Combination of complete resection and lymph nodes dissection, with postoperative adjuvant chemotherapy based on platinum/3rd generation medicine, have preliminarily been justified and proved an important approach for effective improvement of long-term survival of lung cancer.