N2期非小细胞肺癌的预后因素分析

Prognostic analysis of N2 non-small cell lung cancer

目的探讨有纵隔淋巴结转移（N2期）的非小细胞肺癌（NSCLC）的外科治疗疗效及影响预后的因素。方法回顾性分析1999年1月至2003年5月手术治疗的117例N2NSCLC患者（男性88例，女性29例，年龄29～79岁）的生存率，分析手术方式（肺叶切除、全肺切除、姑息性切除），病理类型（腺癌、鳞状细胞癌、混合癌、大细胞癌和其他类型），T分期以及术后综合治疗对预后的影响。结果中位生存期为22个月，3年和5年生存率分别为28．1％和19．0％。年龄、性别、病理类型、围手术期化疗、术后放疗均未见与5年生存率有相关性。肺叶切除者的5年生存率为22．2％，全肺切除者为25．0％，均高于姑息性切除者的9．1％（P=0．001）。T4期患者5年生存率为11．1％，低于T1．2期患者的37．5％（P=0．01）。COX多因素分析示，手术方式和T分期与5年生存率相关。结论外科治疗对T1-2N2期NSCLC是最佳选择。对于T4期患者，由于不完全切除比例大，术前新辅助治疗比率低，手术提高长期生存率的效果有限。

Objective To evaluate the surgical therapeutic strategy and prognostic factors for nonsmall cell lung cancer （ NSCLC ） with mediastinal lymph node metastasis （ N2 ）. Methods The survival rate of 117 patients with N2 NSCLC treated surgically from January 1999 to May 2003 were analyzed. There were 88 male eases and 29 female eases, aged from 29 to 79 years. The procedure of operation （ lobectomy, pneumoectomy and palliative resection ）, histological classification （ squamous cell carcinoma, adenocarcinoma, mixed carcinoma, and large cell carcinoma and others）, T primary tumor status, and adjuvant therapy were analyzed to determine their impact on the 5-year survival rate. Results The median survival time was 22 months, and the over-all 3- and 5-year survival rate was 28. 1% and 19. 0%. Survival was higher in patients with lobectomy than with palliative resection, with T1 and T2 than with T4. The 5- year survival rate had no deference in age, sex and different histological classification. The 5-year survival rates of lobectomy and pneumoectomy （22. 2% and 25.0% respectively） was higher than palliative resection （9. 1% ）. Conclusions Surgical procedures （especially lobectomy） is the best choice for N2 NSCLC patients with T1 or T2. But it can not prolong T4 patients＇ life significantly.