T_(1～4)N_0M_0期非小细胞肺癌根治术后是否需要辅助治疗

Does T 1～4 N 0 M 0 non small cell lung carcinoma need postoperative treatment after radical surgery ?

目的 探讨非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） Ｎ０ Ｍ０ 期根治术后不同病理及不同 Ｔ 分期的转归及治疗。方法 行根治术后病理为 Ｎ Ｓ Ｃ Ｌ Ｃ 的 Ｔ１ ～４ Ｎ０ Ｍ０ 期３５４ 例。男性２８５ 例，女性６９ 例。鳞癌１９１例，腺癌１６３ 例。鳞癌中 Ｔ１ Ｎ０ Ｍ０ 期２７ 例， Ｔ２ Ｎ０ Ｍ０ 期１３４ 例， Ｔ３ Ｎ０ Ｍ０ 期２８ 例， Ｔ４ Ｎ０ Ｍ０ 期２ 例。腺癌中 Ｔ１ Ｎ０ Ｍ０ 期４２ 例， Ｔ２ Ｎ０ Ｍ０ 期１０８ 例， Ｔ３ Ｎ０ Ｍ０ 期１０ 例， Ｔ４ Ｎ０ Ｍ０ 期３ 例。结果 全组５ 年生存率为５３ ．７ ％ ，鳞癌为５９ ．７ ％ ，腺癌为４６ ．６ ％ 。鳞癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为７０ ．４ ％ ，６４ ．９ ％ ，２８ ．６ ％ 及０／２（ Ｐ＜ ０ ．０５） ；局部复发率分别为１４ ．８ ％ ，９ ．７ ％ ，２１ ．４ ％ 及０／２（ Ｐ＞ ０ ．０５） ；远地转移率分别为１１ ．１ ％ ，２３ ．９ ％ ，５０ ．０ ％ 及２／２（ Ｐ＜ ０ ．０５） 。腺癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为６１ ．９ ％ ，４４ ．４ ％ ，２０ ．０ ％ 及０／３（ Ｐ＜ ０ ．０５） ；

Objective Evaluation of different pathologic types and different T stages in the operated N 0 M 0 non small cell lung carcinoma (NSCLC) . Methods From January 1965 to March 1989, 354 operated T 1～4 N 0 M 0 NSCLC patients were treated, 285 male, 69 Female. Pathology: Squamous cell carcinoma 191 and adenocarcinoma 163. The stages of the former: T 1 N 0 M 0 27, T 2 N 0 M 0 134, T 3 N 0 M 0 28, and T 4 N 0 M 0 2. Those of the latter: T 1 N 0 M 0 42, T 2 N 0 M 0 108, T 3 N 0 M 0 10 and T 4 N 0 M 0 3.Results The overall 5 year survival rate was 53.7% , the squamous cell carcinoma patients 59.7% and the adenocarcinoma patients 46.6% (P<0.05). The 5 year survival rates of squamous cell carcinoma patients, T 1 N 0 M 0 , T 2 N 0 M 0 ,T 3 N 0 M 0 and T 4 N 0 M 0 gave 5 year survival rates of 70.4%, 64.9%, 28.6% and 0/2, respectively, The difference between T 1 N 0 M 0 +T 2 N 0 M 0 and T 3 N 0 M 0 +T 4 N 0 M 0 was significant (P< 0.05 ); The local recurrence rates were 14.8% , 9.7% , 21.4% and 0/2 (P>0.05); Distant metastasis rates were 11.l% , 23.9% ,50.0% and 2/2 (P<0.05). In adenocarcinoma patients, the 5 year survival rates of T 1 N 0 M 0 , T 2 N 0 M 0 ,T 3 N 0 M 0 and T 4 N 0 M 0 were 61.9% , 44.4% , 20.0% and 0/3 (P<0.05); The local recurrence rates were 7.1%, 4.6% , 4/10 and 0/3 (P>0.05); Distant metastasis rates were 16.7% , 46.3% ,8/10 and 3/3 (P<0.05).Conclusions (1)The 5 year survival rates of patients with T 1 N 0 M 0 squamous cell carcinoma and adenocarcinoma are high, postoperative adjuvant treatment is unnecessary;(2)Postoperative radiotherapy is unnecessary for the patients of T 1～2 N 0 M 0 stage; (3) Patients with T 3 N 0 M 0 squamous cell carcinoma and T 2～4 N 0 M 0 adenocarcinoma are suggested to receive chemotherapy in order to lower the distant metastasis and improve the long term survival.