术后放射治疗在PN2期非小细胞肺癌中的地位

The Role of Postoperative Radiotherapy on Stage N2 Non-small Cell Lung Cancer

背景与目的术后放射治疗在PN2期非小细胞肺癌(NSCLC)治疗中的临床价值尚无肯定结论。本研究分析术后放疗在PN2期NSCLC各亚组中的疗效,为选择适合术后放疗患者提供依据。方法回顾性分析2000年3月-2005年7月在我院接受手术治疗的PN2期NSCLC病人的临床资料。有符合条件的359例病人可供分析,其中术后放疗病人104例,术后化疗患者共207例。分析PN2期NSCLC总生存期(OS)的影响因素,将全组按肿瘤大小及淋巴结转移站数分组,分析术后放疗在各组中的疗效,以找出可从术后放疗中获益亚组患者。观察终点为OS和无局部复发生存率(LRFS)。统计分析采用Kaplan-Meier法计算生存率,采用Log-rank比较各组生存的差异。结果全组存活病人中位随访时间2.3年,至随访之日224例病人死亡,全组病人中位生存期为1.5年,1、3、5年生存年率分别为78%、38%和26%。单因素分析发现,肿瘤直径>3cm(P<0.001)、多站淋巴结转移(P=0.004)、术后放疗(P=0.047)影响PN2期NSCLC的生存率。全组术后放疗与未放疗患者的5年生存率分别为29%、24%(P=0.047)。亚组中,肿瘤最大直径≤3cm组放疗与未放疗患者的5年生存率及5年LRFS分别为42%、50%(P=0.900)和58%、40%(P=0.085);肿瘤最大直径>3cm组分别为33%、15%(P=0.002)和62%、48%(P=0.033)。单站淋巴结转移组放疗与未放疗患者的5年生存率及5年LRFS分别为30%、40%(P=0.557)和50%、30%(P=0.420);多站转移组分别为36%、20%(P=0.013)和65%、48%(P=0.006)。结论术后辅助放疗可提高PN2期NSCLC的生存率。在PN2组,肿瘤直径>3cm、多站淋巴结转移的亚组患者可从术后放疗中获益。

Background and objective The clinical value of postoperative radiotherapy（PORT） in stage N2 nonsmall-cell lung cancer（NSCLC） is controversy.The aim of this study is to analyze the efficacy of PORT in subgroup of stage N2 NSCLC,which can help clinicians to choose proper patients for PORT.Methods Clinical data of 359 patients with stage N2 NSCLC treated with radical surgery between Mar.2000 and Jul.2005 were retrospectively reviewed.Two hundred and seven patients received adjuvant chemotherapy and one hundred and four patients received adjuvant radiotherapy.First,the group of patients were analyzed to evaluate the factors affecting the overall survival.The all patients were divided based on tumor size and the number of lymph node metastasis station（single station or multiple station） so as to evaluate the role of PORT.The endpoint was overall survival（OS） and local recurrence-free survival（LRFS）.Kaplan-Meier method was used to calculate the OS,LRFS and Log-rank was used to compare the difference in OS and LRFS between different groups.Results The median duration of follow-up was 2.3 years.224 patients died.The median survival was 1.5 years and 1,3,5-year survival were 78%,38% and 26%.Univariate analysis showed tumor size,the number of lymph node metastasis station and PORT were correlated with OS.Among patients,5-year survival rates in PORT and non-PORT were 29% and 24%（P=0.047） respectively.In subgroups,PORT was related with high survival in patients with multiple station N2 compared to non-PORT：36% vs 20%（P=0.013） and 33% vs 15%（P=0.002） in patients in patients with tumor size3 cm.Also,it was related with low local recurrence compared to non-PORT：65% vs 48%（P=0.006） and 62% vs 48%（P=0.033）.Conclusion PORT can improve overall survival for N2 NSCLC,especially the patients with the factors as follows：tumor size3 cm and multiple station N2 can benefit from PORT more or less.