跨肺裂型非小细胞肺癌患者手术预后分析及分期探讨

Prognosis and staging of non small cell lung cancer that extends across the fissure into adjacent lobe

目的探讨肿瘤跨肺裂侵犯对非小细胞肺癌（NSCLC）患者术后生存率的影响及合适的TNM分期。方法回顾性分析上海肺科医院1997年至2007年接受根治性非小细胞肺癌手术病例临床和随访资料。将术后病理证实的非小细胞肺癌患者，按原发肿瘤是否跨肺裂侵犯，分别统计性别、年龄、吸烟史、肺功能、肿瘤部位、肿瘤大小、手术方式、淋巴结转移情况、TNM分期、病理类型，运用Kaplan—Meier生存分析和Cox比例风险模型，对预后因素进行分析。结果跨肺裂侵犯（CF组）入组163例，肿瘤局限单肺叶（SL组）入组326例。根据IASLC最新推荐的第7版TNM非小细胞肺癌的分期，其中Ⅰa期10例（6．1％）、Ⅰb期79例（48．5％）、Ⅱa期5例（3．1％）、Ⅱb期44例（27．0％）、Ⅲa期25例（15．3％）。CF组与sL组各期5年生存率分别为：Ⅰ期51％对63％，P〈0．05；Ⅱ期38％对36％，P=0．472、Ⅲa期27％对25％，P=0．422。按照T分期比较5年生存率，1、2期cF组与sL组比较：35％对50％（P：0．022）；CF组T2期与sL组1、3期比较35％对28％（P=0．111）。结论Ⅰ期非小细胞肺癌患者伴跨肺裂侵犯邻近肺叶者，术后5年生存率较Ⅰ期不跨肺裂者低，为50％对63％，差异有统计学意义（P〈0．05）；t2大小的肿瘤伴跨肺裂侵犯邻近肺叶者低于T2不跨肺裂者（P〈0．05），5年生存率与L不跨肺裂组相近。肿瘤跨肺裂侵犯的T分期定义在当前分期系统中未明确提及，应当在以后的TNM分期中进一步修改。

Objective To determine the prognosis and staging non small cell lung cancer （NSCLC） that extends across the fissure into adjacent lobe after surgery. Methods 3752 patients with histopathologically confirmed non small cell lung cancer （NSCLC） received surgical recessetion from January, 1997 to April, 2007. Anmng them, 163 patients have a tumor invasion beyond fissure. After matching by pathologic TNM staging （7th）, 326 patients whose tumor defined in a single lobe were eligible for analysis. Results Histopathologic staging of nmtched patients was I a： 10 patiens（6.1% ）, I b：79 patients （48.5%）. II a：5 patients （3.1%）, III ：44 patients （27, 0% ） and IIIa：25 patients（ 15.3% ）. 5 years survival in patients with stage I tumors crossing the interlohar fissure was 51%, while in patients not cross the interlobar fissure was 63% （ P 〈 0.05 ）. There was no difference in survival for tumors stage Ifa and above with regard to importance of interlobar extension. The T2 tumor extending across a lung fissure had a reduction in survival compared with T2 tumor not cross the lung fissure and similar to the T3 tumor without the fissure invasion. Conclusion Our results suggest that TNM staging should be modified for tumor extends the fissure into adjacent lobe.