非小细胞肺癌侵犯胸内大血管手术与非手术预后对比分析

Comparative analysis of prognosis between surgical or non surgical treatment for non small cell lung cancer with great vessel invasion in chest

目的:对比常规外科手术和化疗、放射治疗肺癌侵犯胸内大血管的预后。方法:回顾性总结2000年—2002年手术切除的55例以及化疗、放疗的47例肺癌侵犯胸内大血管患者资料,对可能影响其生存率的各种因素进行分析和预后对比。结果:55例手术患者中位生存时间(median survival time,MST)为13个月,1、3、5年生存率分别为58.18%、10.91%、3.9%,47例未接受手术患者MST为16个月,1、3、5年生存率分别为65.96%、22.46%、4.29%;102例患者是否接受手术,生存率无统计学差异(P>0.05)。单因素分析分期、PS评分、化疗、放疗与预后相关,多因素分析分期、化疗、放疗是影响生存的独立因素(P<0.05)。结论:对于侵犯心脏、大血管的T4期肺癌常规手术和化疗、放疗生存相仿,正确选择病例和良好的手术技术能确保完全切除,提高生存率;术后辅助化疗、放疗有助于延长术后生存期。

Objective： To compare the prognosis induced by conventional surgery and chemotherapy and radiotherapy for nonsmall cell lung cancer （NSCLC） with great vessel invasion in chest. Methods：Clinical data from 102 NSCLC patients with great vessel invasion in chest, treated from 2000 to 2002 in our hospital, were reviewed retrospectively. There were 55 patients who received surgical resection and 47 patients who received chemotherapy and radiotherapy. The multiple factors affecting the survival rate and prognosis of patients were analyzed and compared. Results： The median survival time （MST） was 13 months and the 1-, 3-, and 5-year survival rate was 58.18%, 10.91%, and 3.9% for55 patients who received surgical treatment. The MST was 16 months and the 1-, 3-, and 5-year survival rate was 65.96%, 22.46%, and 4.29%, respectively, for 47 patients who received non surgical management. There was no significant difference in survival rate between surgical and non surgical management （ P 〉 0.05 ）. Univariate analysis showed that clinical staging, PS score, chemotherapy, and radiotherapy were related with prognosis. The multivariate analysis demonstrated that clinical staging, chemotherapy, and radiotherapy served as independent survival factors （P 〈 0.05）. Conclusions： There was no statistical difference in the survival rate of NSCLC patients at T4 stage with heart and great vessel invasion who received conventional surgery and chemotherapy and radiotherapy. Correct patient selection and skilled surgical technique assured complete tumor resection and increased the survival rate. Adjuvant chemotherapy or radiotherapy helped to prolong the post-operative survival time of patients.