263例老年非小细胞肺癌的外科治疗

Non-small-cell lung cancer in elderly patients:surgical treatment of 263 cases

目的探讨70岁以上老年人非小细胞肺癌手术治疗的结果及围手术期处理。方法回顾分析中国医学科学院肿瘤医院胸外科自1998年1月至2004年1月5年间,手术治疗的70岁以上老年非小细胞肺癌患者263例,年龄70～83岁,平均73岁。70～75岁的患者223例(84.8%),76～83岁40例(15.2%)。均随访满5年,生存数据统计到2009年1月,随诊率92.5%。结果术后病理结果:鳞癌124例(47.1%),腺癌89例(33.9%),腺鳞癌28例(10.6%),肺泡细胞癌17例(6.5%),大细胞癌5例(1.9%)。术后临床病理TNM分期:Ⅰ期为35例(13.3%),ⅠA9例,ⅠB26例;Ⅱ期为92例(35.0%),ⅡA31例,ⅡB61例;Ⅲ期为136例(51.27%),ⅢA106例,ⅢB30例。全肺切除19例(7.2%);肺叶切除197例(72.6%),复合肺叶切除16例(6.1%),肺叶支气管袖状切除9例(3.4%),楔形切除或肺段切除22例(8.4%)。Ⅰ期、Ⅱ期、Ⅲ期的5年生存率分别为66.5%,38.3%,16.2%(P<0.05)。本组术后总的1、3、5年生存率分别为69.2%、41.2%、28.7%。58例术后发生并发症,并发症发生率为22.0%。围手术期死亡率为1.9%。结论对于70岁以上老年非小细胞肺癌患者,通过严格选择手术适应证和手术方式,再加上周密的围术期处理,患者术后可获得相对较好的远期预后。

Objective To study the prognosis of non-small-cell lung cancer（NSCLC） in elderly patients after surgery. Methods The record of of 263 survival elderly patients with NSCLC who underwent surgery from 1999 to 2004 was statistically analyzed by the Kaplan-Meier method. Comparison of the differences in survival rates among groups was made according to the log rank test. The follow-up time was at least 5 years with a follow-up rate of 92.5%. Results Of 263 cases, 35（13.3 %） patients were in the stage I of cancer, 92（35.0%） in stage Ⅱ , 136 （51.27%） in stage Ⅲ. Surgical procedures included segmentectomy and wedge resection for 22 patients（＆ 4% ）, lobectomy for 197 cases （72.6%） ,bilobectomy for 16 cases （6. 1% ） ,sleeve lobectomy for 19 patients（7.2%）, and pneumonectomy for 9 patients（3.4% ）. The overall 1-, 3-, 5-year survival rates for elderly patients with pathologic stage lesion were 69.2%, 41.2% and 28.7%. The 5-year survival rates for stage Ⅰ, Ⅱ ,Ⅲ were 66.5%, 38.3% and 16.2 %. respectively （P〈0.05）. Fifty-eight eases （22.0 % ） had severe complications and early operative mortality was 1.9 % after lung cancer surgery. Conclusion Elderly patients with non-small-cell lung cancer should undergo surgical therapy. Operative indications and careful perioperative management are necessary for obtaining good thera- peutic results and long-term prognosis in elderly patients.