Ⅲ期非小细胞肺癌新辅助化疗后手术的预后因素分析

Analysis of Prognosis Factors for Operation after Neoadjuvant Therapy for Stage Ⅲ Non Small Cell Lung Cancer

目的:探讨Ⅲ期非小细胞肺癌(NSCLC)新辅助化疗后影响手术并发症和生存期的相关危险因素。方法:152例ⅢA、ⅢB期NSCLC患者接受新辅助化疗和手术,收集其术前功能性指标、分期、并发疾病、化疗方法、手术方式、术后并发症、生存期等资料,采用卡方检验、Kaplan-Meier和Cox比例风险模型分别分析影响术后并发症和生存期的危险因素。结果:单因素分析显示第1秒用力呼气量占预计值百分比(FEV1%,P=0.040)和术前并发疾病(P=0.020)对手术并发症的发生有影响。Kaplan-Meier生存分析分期(P=0.050)和是否全肺切除(P=0.018)对术后生存时间有影响。进一步多因素Cox回归分析示,只有全肺切除对术后生存时间有影响(P=0.026),而左、右全肺切除无区别(P>0.05)。结论:Ⅲ期NSCLC新辅助化疗的术后并发症危险因素是可接受的。全肺切除是影响患者生存期的高危因素。

Objective：To explore the predictive factors for postoperative complications and survival time after neoadjuvant therapy for advanced stage Ⅲ non small cell lung cancer （NSCLC）. Methods：One hundred fifty-two patients （116 males and 36 females） underwent neoadjuvant therapy and surgery for stage IliA and B NSCI.C. The demographic data, preoperative functional parameters, staging, associated disorders, chemotherapy or radiotherapy, type of operation, postoperative complication and survival time were collctecl. Chi square test was performed to identify predictors of postoperative complications, while Kaplan- Meier and multivariate Cox proportional hazard model were performed to identify predictors of survival time ,respectively. Results： The univariate analysis demonstrated that forced expiratory volume in 1 second predicted percent （FEV1 %, P = 0. 040） and associated disorders （P = 0. 1120） were the predictive factors of complications, Kaplan-Meier analysis showed that stage （P = 0. 050） and whether pneumonectorny or not （P=0. 018） affected the survival time. However, multivariate Cox proportional hazard model analysis demonstrated that only pneumonectomy （P = 0. 026） was associated with an decreased survival time with no differences between right and left pneumonectomy. Conclusion：The risk factor of complications is acceptable. Pneumonectomy is associated with an increased risk of mortality and should be performed in selected stage Ⅲ NSCLC patients.