新辅助化疗肺癌患者长期随访结果分析

Investigation of long-term outcome for lung cancer of patients with neoadjuvant chemotherapy

目的探讨新辅助化疗肺癌长期生存率及预后影响因素。方法回顾性分析1995年6月至2007年5月256例新辅助化疗后进行外科治疗的肺癌患者的临床资料。对性别、年龄、P—TNM分期、肿瘤大小、淋巴结转移情况、病理类型、手术性质和手术方式进行单因素和多因素分析，用Kaplan—Meier法绘制生存曲线和计算生存率，Log-rank检验进行生存率显著性检验。评价可能的预后因素对长期生存的影响。结果本组手术切除率100％，无手术死亡病例，发生术后并发症11例（4．3％）。根治性手术236例（单纯肺叶切除169例，全肺切除53例，扩大切除14例），姑息性手术20例。全组1、3和5年生存率分别为79．3％、38．7％和27．0％。单因素分析显示，年龄、p-TNM分期、肿瘤大小、淋巴结转移情况和手术方式是影响新辅助化疗患者术后长期生存的因素。多因素分析显示，p-TNM分期（OR：1．323，95％CI：1．068～1．641，P=0．017）和年龄（OR=1．562，95％CI：1．148～2．125，P=0．005）是影响预后的独立危险因素。结论新辅助化疗可以提高肺癌患者的长期生存率。p-TNM分期和手术方式是影响新辅助化疗患者术后长期预后的主要因素。

Objective To evaluate and analyze prognostic factors for surgical treatment of patients with neoadjuvant chemotherapy. Methods Records of 256 patients who underwent operation after chemotherapy for lung cancer from June 1995 to May 2007 were reviewed retrospectively. Potential prognostic factors which were univariately and multivariately analyzed by COX proportional hazard regression model, included gender, age, p-TNM stage, size of tumor, metastasis of lymph node, histological type and operation extent. Kaplan-Meier method was used for survival curve and rate. However, survival difference was calculate by Log-rank test. Results Eleven patients （4. 3% ） developed postoperative complications. Two hundred and thirty-six patients （ 92. 2% ） underwent radical resection （ 169 for lobeetomies, 53 for pneumonectomies and 14 for extended resections）. On the contrary, 20 cases had palliative resection. The overall 1-, 3- and 5-year survival rate was 79. 3% , 38.7% and 27.0% respectively. Age, p-TNM stage, size of tumor, metastasis of lymph node and type of operation were valued as prognostic factors in COX univariate analysis, p-TNM stage （ OR = 1. 323, 95% CI： 1. 068 to 1. 641, P = 0. 017） and age （ OR = 1. 562, 95% CI： 1. 148 to 2. 125, P = 0. 005） were identified independent prognostic factors in COX multivariate analysis. Conclusions Long-term outcome for lung cancer of patients with neoadjuvant chemotherapy are encouraging, p-TNM stage and surgical type are the crucial prognostic factors for surgical treatment of patients with neoadjuvant chemotherapy.