侵及邻肺叶的非小细胞肺癌与可手术的T4患者的术后生存比较

Postoperative survival comparison of non-small cell lung cancer between disease with peripheral direct adjacent invasion and resectable T4 disease with mediastinal structures invasion

目的分析经手术治疗的直接侵犯邻肺叶的非小细胞肺癌（NSCLC）的预后情况，并与经手术治疗的纵隔重要结构受侵犯的T4患者的预后情况进行比较，为更合理地对直接侵犯邻肺叶的周围型NSCLC进行T分期提供线索。方法所有患者均接受手术治疗，并且均为术前临床分期和术后病理分期均为NOM0的NSCLC患者。从1997年3月到2006年10月，广州中山大学肿瘤防治中心共有49例患者符合人组条件。其中28例直接侵犯邻肺叶的周围型NSCLC归于A组，21例直接侵犯纵隔重要结构的T4患者归于B组。对这两组患者的临床病理资料，中位生存期和长期生存率进行计算和比较。两组间生存率的比较用Log—Rank检验。结果两组的性别、年龄、病理类型、肺功能和术后辅助治疗情况具有较好的均衡性。A组有1例发生围术期死亡。A组的2年、3年和5年生存率分别为68．7％、61．1％和40．7％；B组的2年、3年和5年生存率分别为64．7％，58．2％，43．7％；A组和B组中位生存期分别为54个月和49个月，两组间生存期的差异无统计学意义（P=0．931）。结论直接侵犯邻肺叶的周围型NSCLC的预后与可手术的侵犯纵隔重要结构的T4患者的预后相似。对部分患者，手术治疗可以取得较为理想的疗效。对于邻近肺叶受侵的NSCLC患者，手术方案应该按照同期双原发肺癌的治疗原则来制定。尚需进一步研究来探讨邻近肺叶受侵的NSCLC的T分期。

Objective To determine the postoperative survival of non-small cell lung cancer with peripheral adjacent lobe invasion by comparing it with that of resectable T4 disease with mediastinal structures invasion, and hence try to find out some clue concerning how to define these patients for a reasonable T stage. Methods A retrospective analysis was conducted to assess the survival of NSCLC patients with peripheral direct adjacent lobe invasion （ group A, n = 28 ）, and compared it with that of with mediastinal structures invasion （group B, n = 21 ）. All patients underwent surgery between March, 1997 and October, 2006, and were pathologically confirmed with N0M0 disease. Kaplan-Meier method was used to calculate the survival, and Log-Rank test was used to compare the postoperative survival between two groups. Results The sex, age, pathology, and pulmonary function were well balanced between the two groups. There was one operative death from group A. The disease specific 2 year, 3year, 5 year survival in group A and group B was： 68. 7% , 61.1% , 40. 7% , and 64. 7% , 58.2% , 43.7% , respectively. The median survival for group A and group B was 54 months and 49 moths, respectively, with no statistically significant difference （P = 0. 931 ）. Condusions NSCLC with peripheral adjacent lobe invasion has a similar survival prognosis with that of resectable T4 disease with mediastinal structures invasion. Among carefully selected patients, long-term survival is anticipated for NSCLC with adjacent lobe invasion. However, further studies are needed to determine the optimal T stage for these patients.