ⅢA(N2)期非小细胞肺癌术后失败模式分析

Research on Postoperative Radiotherapy for Non-small Cell Lung Cancer of Stage ⅢA(N2) according to the Failure Patterns after Pulmonary Resection

背景与目的术后放疗可降低局部复发率,但是否可提高ⅢA(N2)期非小细胞肺癌(non-small cell lung cancer,NSCLC)生存率依然存在争议。本文将分析术后放疗的疗效、术后失败的方式及影响局部复发的因素。方法回顾性分析ⅢA(N2)NSCLC行肺切除加纵隔淋巴结清扫术,术后失败模式在局部和(或)远处,分析术后放疗对其的疗效。影响局部复发的因素及不同原发部位与术后局部复发方式的关系。结果多因素分析显示T分期(P<0.001)、术后病理(P=0.038)、手术方式(P=0.013)及转移淋巴结组数(P=0.018)是独立的复发因素。袖状切除局部复发多出现在残端(P<0.001),而肺叶和全肺切除纵隔淋巴结复发多(P=0.025);鳞癌易发生纵隔淋巴结的复发(P=0.023),腺癌易出现远处转移(P=0.001),T分期中T1与T2-3纵隔淋巴结区的复发率分别为36.4%、62.0%(P=0.009)。原发部位不同出现的局部复发部位不同。结论ⅢA(N2)期NSCLC术后病理、T分期、手术方式是独立的复发因素。术后复发部位与手术方式、肿瘤T分期、病理类型、原发部位有关。

Background and objective Postoperative radiotherapy （PORT） after complete resection of non-small cell lung cancer （NSCLC） has been introduced in order to reduce locoregional recurrence, but it remains controversy whether PORT can improve survival. Therefore, we want to investigate the effect of PORT and the relationship between failure patterns and primarily location of stage iIIA （N2） in NSCLC. Methods This retrospective analysis included 233 patients who underwent resection of NSCLC, first recurrence involving a local-regional site. It illustrated the factors affecting local recurrence and the sites of failure on the basis of lobe of primary tumor. Results Multivariable analysis demonstrated the number of positive lymph nodes （P=0.003）, T stage （P〈0.001）, histological type （P=0.038）, modus operandi （P=0.013） and the number of mediastinal lymph node stations involved （P=0.018） were the independent factors. For all patients, the most common site of failure was the bronchial stump/staple line, which was present more often in those who had a wedge resection than in those who had a more radical procedure （P〈0.001）. The local-region frequency of squamous was higher than adenocarcinoma carcinoma （P=0.025）. The recurrence frequency ofmediastinal lymph node among T1 and T2-3 were 36.4%, 62.0% （P=0.009） respectively. The local- region recurrence among primarily tumor location were different. Conclusion The number of positive lymph nodes, T stage, histological type, modus operations and the number of mediastinal lymph node stations involved were the independent factors in IIIA （N2） NSCLC.