IIIa期非小细胞肺癌手术与术后辅助治疗疗效比较的回顾性分析

Retrospective study on surgery and post-operative adjuvant treatment in stage IIIa non-small cell lung cancer

目的回顾性分析和比较非手术治疗、单纯手术治疗和手术后化放疗对IIIa期非小细胞肺癌患者生存时间的影响,并简要分析影响IIIa期非小细胞肺癌预后的因素。方法从1997年1月1日～2004年12月31日北京大学第一医院胸外科病房住院治疗肺部恶性肿瘤的856例患者中,依据相应的入选标准筛选出IIIa期非小细胞肺癌患者87例,采用查阅病历、电话以及信件等方式随访,了解患者手术后治疗情况、生存时间及生活质量等资料。获得随访资料的病例50例,随访率57.48%。对于获得随访资料的患者,统计术后1、3及5年生存率;将入选行手术治疗的病例分为单纯手术组和手术+术后辅助治疗组,使用Kaplan-Meier法进行差异性分析;将未手术患者和单纯手术治疗的患者分组对照,比较各自的生存曲线。结果入选病例术后1、3及5年生存率分别为80.49%、34.62%和29.67%;从单纯手术和术后化放疗组的生存曲线来看,差异无显著性(P=0.0722)。对于非手术治疗患者,手术组患者表现出更高的生存率,差异具有统计学意义(P=0.0073)。结论对于能完全切除的IIIa期非小细胞肺癌,手术是其基本治疗手段;对于完全切除的IIIa期非小细胞肺癌,手术后辅助化、放疗可能有提高患者术后生存率的倾向。

[Objective] To retrospectively analyze and compare the impacts on stage IIIa NSCLC patients＇ survival time of non-surgical, single surgical treatment, and post-operative adjuvant treatment, and to simplistically analyze factors that may impact the prognosis of stage Ⅲa NSCLC. [Methods] Following relevant criteria, 87 stage Ⅲa NSCLC patients were selected from 856 patients who received in-patient treatments at the Department of Thoracic Surgery of the Peking University First Hospital from 1/1/1997 to 12/31/2004. Then patients＇ post-operative treatment information, survival time, and quality of living from 50 patients were available and the percentage of availability was 57.48%. For these patients, Post-operative 1, 3, and 5 year-survival rates were summarized by using SPSS （version 10.0）; Patients who received surgery were further classified into those who received just surgery and those who also received post-operative adjuvant treatment which were differentiated by the Kaplan-Meier approach; The survival curves of the only-surgery and non-surgical group were also compared. [Results] The 1, 3, 5-year survival rates of the selected patients were 80.49%,34.62%, and 29.67%; Statistically significant result was not obtained from the comparison between the survival curves of the only-surgery and post-operative adjuvant treatment group （P=0.0722） while the small p-value may indicate higher survival rates of patients who received post-operative adjuvant treatment; Patients who received single surgery treatment had higher survival rates than those who didn＇t receive surgery and the different is statistically significant （P =0.0073）. [ Conclusions] Surgery is the basic treatment for stage Ⅲa NSCLC which could be surgically removed; It＇s likely that post-operative adjuvant treatment could increase the survival rates of patients with surgically removable stage Ⅲa NSCLC.