外科治疗III_A期N_2非小细胞肺癌的预后分析及临床意义

Analysis correlating clinical features and prognosis in the resected N2 non-small cell lung cancer

目的探讨影响IIIA期N2非小细胞肺癌(NSCLC)预后的因素,并分析经手术治疗不同亚组病人的生存率差异。方法分析1997年1月至2000年1月146例手术治疗的IIIA期N2NSCLC病人的可能影响预后因素:病理类型、肿瘤位置、肿瘤大小、手术方式、临床N2情况,N2转移组数及个数、术后辅助治疗等,并用Kaplan-Meier曲线及Logrank检验生存率差异,Cox单因素、多因素分析各因素对生存率的影响。结果IIIA期N2NSCLC病人的3年和5年生存率分别为19.86%和14.56%。单因素分析示肿瘤位置、临床N2情况、N2转移组数及个数是影响生存率的因素;多因素分析示肿瘤大小、临床N2情况,N2转移组数和肿瘤位置影响预后。右肺下叶肿瘤单组或单个N2转移,预后最好。结论纵隔N2转移淋巴结的大小、个数和组数是影响术后生存率主要因素。手术前未发现N2转移(mN2),有1组N2转移(N2L1),N2转移数少于4个者手术治疗效果好。右肺下叶肿瘤发生单组N2淋巴结转移预后好。

Objective Non-small-cell lung cancer with ipsilateral mediastinal lymph node metastasis （N2） belongs to heterogeneons subgroup. We analyzed the prognosis of patients with resected N2 NSCLC to determine the clinical significance. Methods The present study comprised 146 consecutive patients whom underwent surgical resection of N2 NSCLC between January 1997 and January 2000. Histological type, location, T primary tumor status, operation mode, clinical N2 （cN2） factor, Nz level（ single or multiple）, number of positive nodes（N2-nuro）, and the cycles of adjuvant chemotherapy were estimated from the date of operation using the Kaplan-Meier and Log Rank analysis. The Cox regression model evaluated the influence of factors on the survival, Results The 3-and 5- year survival rate of these N2 NSCLC patients were 19.86% and 14.56%, respectively. The patients with tumor in the right lower lobe showed a significantly longer survival than left lobes. The histological type, tumor location, cN2 factor, N2 level and N2-number were associated with survival. A multivariate analysis using Cox regression identified 4 factors of prognosis： tumor site, T status, N2 level and clinical N2 status. Conclusion This article has identified N2 NSCLC subgroups and found that patients with mN2, N2L1 and single N2 have better prognosis.