非小细胞肺癌的减量性手术治疗

Debulking operation for non small cell lung cancer

目的探讨非小细胞肺癌减量性手术的疗效和影响因素。方法用ＳＰＳＳ统计软件包的Ｋａｐｌａｎ－Ｍｅｉｅｒ和Ｃｏｘ模型，分析比较２４４例肺癌减量术及同期３６４例剖胸探查术的累积生存率和影响生存率因素。结果非小细胞肺癌减量术的１，３，５年累积生存率分别为５６．９％、２０．６％和１７．５％；探查术为４１．１％、７．８％和５．３％。两者比较，Ｂｒｅｓｌｏｗ＝２７．５５，Ｐ＜０．０００１。多因素分析显示，影响生存的主要因素为手术性质（减量术或探查术，Ｂ＝－０．４６００，Ｐ＜０．０００１）和有否后续治疗（Ｂ＝－０．１０５９，Ｐ＝０．０２１６）。结论肿瘤减量性手术是Ⅲ、Ⅳ期非小细胞肺癌的重要治疗手段之一，术后行放疗、化疗能有效地提高患者的生存率。

Objective To assess effectiveness and influencing factors of debulking operation for non small cell lung cancer. Methods The cumulative survival and its influencing factors were analyzed and compared by the Kaplan Meier and Cox model of SPSS for Windows in 244 patients received debulking operation and 364 received thoracotomy.Results The 1,3,5 year cumulative survival of patients treated with debulking operation was 56.9%, 20.6%, 17.5% respectively while that received thoracotomy was 41.1%, 7.8%, 5.3%, respectively (debulking vs thoracotomy, Breslow=27.55, P <0.0001). Multivariate analysis showed that the debulking operation or thoracotomy (B=-0.4600, P <0.0001) and postoperative adjuvant therapies (B=-0.1059, P =0.0216) were the most important influencing factors on the cumulative survival. Conclusion Tumor debulking operation is an important treatment for stage Ⅲ、Ⅳ non small cell lung cancer. With postoperative adjuvant chemoradiotherapy better survival can be achieved.