非小细胞肺癌术后支气管切缘癌与预后

Study of Residual Tumor on the Bronchial Margin After Resection for Non Small Cell Carcinoma of the Lung

为探讨肺癌术后支气管切缘癌的发生率及预后特点，提高肺癌５年生存率，回顾总结１９８１～１９９０年经手术治疗１０２４例非小细胞肺癌，显微镜下发现支气管残端癌阳性者８９例占８．７％。此８９例病人平均５年生存率２３．７％。中位数生存期２７．６个月。其中ＰＴＮＭＩ、ＩＩ、ＩＩａ和ＩＩｂ期病人平均生存期分别为４４．３、２７．１、１２．４和１２．６个月，鳞癌、腺癌、大细胞癌及鳞腺混合癌病人的平均生存期分别为３１．０、１９．３、１４．８和２８．３个月。结论：影响病人预后的因素主要是病变的ＴＮＭ分期及细胞类型。

Aim:To summarize the incidence and clinical characteristics of residual carcinoma on the bronchial margin after resection for non small cell carcinoma of the lung.Clinical material and method:1024 patients with non small cell carcinoma of the lung underwent surgery from 1981 to 1990.Among them,89 patients(8.9%)were found having microscopic residual tumor on the bronchial margin.There were 74 men and 15 women.The mean age was 56.6 years with a range of 31 to 71 years.Surgical procedures performed consisted of lobectomy in 63,pneumonectomy in 25 and sleeve resection in 1.63 patients had squamous carcinoma,20 had adenocarcinoma,3 had large cell carcinoma and 3 had adenosquamous carcinoma.According to pTNM classification,stage I was in 24 patients,stage II in 40,Stage IIIa in 21 and stage IIIb in 4.81 patients were followed up more than 5 years postoperatively with a follow up rate of 91%.33 patients had postoperative radiotherapy,21 had chemotherapy,23 had combined radiotherapy and chemotherapy,and 12 had no further treatment after operation.2 patients required re operation for their lung cancer.Results:There were no operative deaths and severe postoperative complications.The overall 5 year survival rate was 23.7% and the median survival time was 27.6 months.The mean survival time was 44.3 months for stage I tumor,27.1 months for stage II,12.4 months for stage IIIa and 12.6 months for stage IIIb.The mean survival time was 31 months for squamous carcinoma,19.3 months for adenocarcinoma,14.8 months for large cell carcinoma and 28.3 months for adenosquamous carcinoma.Conclusion:The surgical outcome is closely related to the stage and pathological type of the tumor.Postoperative radiotherapy and chemotherapy should be employed for patients with residual tumor on the bronchial margin after resection.