Ⅲ_a期非小细胞肺癌术后放疗和化疗的失败原因分析

Patterns of Disease Failure of Postoperation Radiotherapy and Chemotherapy in Radically Resected Stage Ⅲ_a Non small cell Lung Cancer

目的 探讨Ⅲａ 期非小细胞肺癌术后放疗和化疗的增益程度及其失败原因。方法 采用单因素和多因素Ｃｏｘ 回归模型，对１０７ 例Ⅲａ 期非小细胞肺癌根治术后放疗和／ 或化疗的疗效增益特点及失败原因分析。结果 其单纯手术（Ｓ） 、手术＋ 化疗（Ｓ＋ Ｃ） 、手术＋ 放疗（Ｓ＋ Ｒ） 、手术＋ 放疗＋ 化疗（Ｓ＋ Ｒ＋ Ｃ）５ 年生存率分别为２０ ．８ ％ 、２４ ．３ ％ 、２５ ．０ ％ 、３４ ．６ ％ 。但接受放疗者５ 年无复发生存率为８８ ．５ ％ ，明显高于未放疗者的６９ ．２ ％ （ Ｐ ＜ ０ ．０５） 。术后化疗者的远处转移时间为２１ ．８ 个月，明显高于未化疗的１４ ．８ 个月，但４ 组的５ 年无转移生存率无明显差异。Ｎ 分期是生存率的独立预后因子（ Ｐ＝ ０ ．０１３） ，并且是远处转移的高危因素（ Ｐ＝ ０ ．０５８６） 。结论 对Ｎ２ 分期亚组患者应采用术后放疗联合化疗。

Objective To study the benefit and failure patterns of radiotherapy and chemotherapy following radical surgery in stage Ⅲ a non small cell lung cancer(NSCLC).Methods Univariate and multivariate Cox analyses were performed.The therapeutic effects of surgery alone(S),plus chemotherapy(S+C),plus radiotherapy(S+R) and plus radiochemotherapy(S+R+C) in 107 cases were evaluated.The 5 year survival rate was 20.8%(S),24.3%(S+C),25.0%(S+R) and 34.6%(S+R+C) respectively( P >0.05).Results The 5 year local failure free survival rate was 88.5% in the patients received radiotherapy,in others,it was 69.2%( P <0.05).The distant metastases time in the patients received chemotherapy was 21.8±8.5 months and it was 14.8±7.8 months in others( P <0.05).However,the 5 year distant metastases free survival rates were not different in all four groups( P >0.05).On multivariate analysis,only N stage was the independent prognostic factor( P =0.013).N 2 lymph nodes involved was the high risk factor of distant metastases.Conclusion For patients with N 2 stage,S+R+C should be a better therapeutic modality.