非小细胞肺癌MVP方案术前化疗临床缓解率和病理改变探讨

A comparative study between clinical response and pathologic changes to preoperative chemotherapy in non small cell lung cancer

目的 研究非小细胞肺癌（ＮＳＣＬＣ）ＭＶＰ方案化疗后临床缓解率和组织分级的关系。方法 对４６ 例Ⅰ～Ⅲａ 期ＮＳＣＬＣ以ＭＶＰ方案行术前化疗１～２ 个疗程，按ＷＨＯ标准评价临床疗效，并对其术后标本进行组织学分级。结果 ①临床缓解率化疗２ 周期显著高于１ 周期者（ Ｐ＜ ０－０１） ，组织学分级达Ⅰ～Ⅱ级者化疗２ 周期亦显著高于１ 周期者（ Ｐ＜ ０－０１） ，但临床缓解率与组织学分级并不完全一致。②原发灶化疗后，组织学分级与肿瘤范围（Ｔ） 有显著相关性（ Ｐ＜０－０１） ，但与局部淋巴结转移（Ｎ） 与否无显著相关性。③化疗疗效需结合临床缓解率与化疗后组织学分级共同评价。④本方案未见严重毒副反应、手术并发症、手术死亡及延长术后恢复时间。

Objective To study the clnical response to preoperative chemotherapy in relation to pathologic changes in non small cell lung cancer (NSCLC).Methods Forty six stage Ⅰ～Ⅲa NSCLC patients were given 1～ 2 courses of preoperative chemotherapy with mitomycin C (MMC) 6 mg.M -2 on day 1, vindesine (VDS) 2.5～3 mg.M -2 on day 1, day 8 and/or day 15, and cisplatin (DDP) 90 mg.M -2 on day 1 (MVP regimen). The treatment was recycled every 28 days. Clinical response was assessed according to WHO criteria. Pathologic changes of the resected tumor were categorized to 3 grades. Grade Ⅰ: No tumor under gross and microscopic observation. Grade Ⅱ: Grossly no tumor present but residual tumor cells under microscopic observation. Grade Ⅲ: Tumor reduced in size with clear margins; marked tumor cells degeneration and necrosis accompanied with fibrosis. Grade Ⅳ: Active proliferation of tumor cells with invasion. Grade Ⅰ～Ⅱ was considered to be chemotherapeutically effective.Results (1) The clinical response rate was higher in patients who had received 2 courses than those received 1 course of treatment. More patients treated with 2 courses had their pathologic changes in Grade Ⅰ～Ⅱ than those treated with 1 course of chemotherapy but the response rate was not fully consistent with pathologic grading. (2) Pathologic grading significantly correlated with the extent of tumor involvement but not with the lymph node status. (3) Efficacy of chemotherapy should be evaluated jointly by the clinical response and grading of pathologic changes. (4) Chemotherapy with MVP regimen did not elicit severe toxic side effect. Nor did it lead to operative morbidity, operative mortality and a delay in postoperative recovery.Conclusion Preoperative chemotherapy with MVP regimen is effective in the treatment of NSCLC in stage Ⅰ～Ⅲa.