531例肺腺癌切除术的治疗效果分析

Results of surgical treatment of adenocarcinoma of the lung

目的 总结肺腺癌的外科治疗结果 ,探讨肺腺癌的临床特点及影响预后的因素。方法 采用STATA统计软件建立病例资料数据库并进行统计分析。生存率用寿命表法计算 ,两组间生存率差异的显著性检验用Logrank检验。结果 无症状体检发现病变者占 14 88% ;周围型病变占 86 18% ;淋巴结转移率为 47 80 %。肺腺癌根治术的 5年生存率为 41 47% ;姑息术为 10 0 3% (P <0 0 5 )。不同TNM分期的 5年生存率分别为 :I期 5 5 0 6 % ;II期 2 9 6 2 % ;IIIa期 10 2 6 % (P <0 0 1)。随机分组术后放疗组的 5年生存率为 12 2 5 % ;单一手术组 14 5 2 % (P >0 0 5 )。结论 肺腺癌无症状体检发现病变者及周围型病变的比例高 ;淋巴结转移率高。手术性质、TNM分期是影响预后的主要因素 。

Objective To evaluate the results of surgical resection and the prognostic factors for adenocarcinoma of the lung. Method 531 patients who underwent resection for pulmonary adenocarcinoma were statistically analyzed using STATA software. The survival rate was calculated with life table method. Comparisons of the difference of survival rates between groups were made according to the log-rank test. Result 14 88%of patients were asymotomatic at the time of diagnosis. The operative mortality rate (30 day) was 0 94% and the morbidity rate was 11 3%. The overall 5 year survival rate was 36 21%,41 47% for the radical resection and 10 03% for palliative resection (P<0.05). The 5 year survival rate was 55 065 for stage I tumor,29.62% for stage II and 10 26% for stage IIIa,0 for stage IIIb and 12 55% for stage IV,respectively (P<0.01). The 5 year survival rate was 12 25% for postoperative radiotherapy group and 14 52% for surgery alone group (P<0.05). The 5 year survival rate was 37 98% for lobectomy,36 36% for sleeve resection,27 84% for pneumonectomy and 16.67% for wedge resection. Conclusion Adenocarcinoma of the lung,often peripherally located,is always asymptomatec at time of diagnosis. It metastasizes early to the lymph nodes and elsewhere via the bloodstream. An asymptomatic tumor is often found on routine X ray exam. Surgical pattern and TNM stage are important factors influencing prognosis. Postoperative radiotherapy does not improve ling term survival rate.