术前新辅助化疗在局部晚期非小细胞肺癌治疗中的应用评价

Evaluation on preoperative neoadjuvant chemotherapy in patient with stage Ⅲ non-small cell lung cancer

目的：探讨新辅助化疗在局部晚期非小细胞肺癌（Locally advanced nonsmall cell lung cancer,LANSCLC）外科手术治疗中的应用价值。方法：从1997年1月-2002年6月,对我院228例局部晚期NSCLC病例进行前瞻性随机对照试验总结分析：试验组95例为术前新辅助化疗病例行术前化疗2-3周期,化疗结束后3-4周手术。对照组133例为同期直接手术的NSCLC病例。结果：试验组化疗总有效率为69.47%（66/95）,病期下调率为35.79%（34/95）,手术切除率试验组为91.57%（76/83）,对照组为81.95%（109/133）,两组手术并发症和手术病死率无显著差异（P〉0.05）,新辅助化疗组术后1、3、5年生存率分别为78.31%、54.22%和36.14%,对照组分别为72.93%,41.35%和25.56%,试验组术后生存率显著高于对照组（P〈0.01）。结论：术前新辅助化疗安全有效,能降低局部晚期NSCLC患者病期,提高手术切除率,改善患者术后长期生存率及生活质量。

Objective：To evaluate the effect of neoadjuvant chemotherapy on surgical patients with locally advanced non-small cell lung cancers.Methods： The data of 228 locally advanced non-small-cell cancer patients admitted to our hospital between January 1997 and June 2002 were randomized into treatment and control group for retrospective analysis.95 in 228 received chemotherapy before the operation（treatment group） for about 2 to 3 cycles followed by the surgery after 3 to 4 weeks.113 controls underwent the operation without chemotherapy.Results： The overall effective rate for the treatment group was 69.47%（66/95） and the rate of shortened treatment course was 35.79%（34/95）.91.57%（76/83） cases in the treatment group were removed with the focus,whereas the control group was 81.95%（109/133）.There was no significant difference between the two groups regarding complications after operation and mortality（P〉0.05）.By neoadjuvant chemotherapy,the survival rate of 1,3 or 5 years was 78.31%,54.22% and 36.14% compared to 72.93%,41.35% and 25.56% from control group,respectively（P〈0.01）.Conclusion： Neoadjuvant chemotherapy before surgery can be safe and effective and shorten the treatment course besides higher removal and improvement of life quality and survival of such patients.