ⅢA—N2期非小细胞肺癌根治性切除术后的复发分析

Analysis of recurrence patterns after curative resection of stage ⅢA-N2 non-small cell lung cancer

目的探讨ⅢA．N2期非小细胞肺癌（NSCLC）患者根治术后肿瘤的复发情况及其相关影响因素。方法回顾北京大学第一医院2004年9月至2008年12月期间行肺癌根治术，并经病理证实为ⅢA，N2期的63例NSCLC患者的临床资料，随访监测肿瘤复发情况，Kaplan—Meier法计算术后复发率，应用Cox比例风险回归模型分析复发影响因素。结果63例患者术后2年和3年复发率分别为46．6％和57．3％，其中主要以转移性复发为主（27／28），局部复发仅1例；Cox单因素回归分析表明肿瘤组织中有淋巴血管侵犯（LVl）术后复发风险是LVI阴性者的2．54倍；N2阳性淋巴结数量〉3者的复发风险是淋巴结数1～3者的2．48倍；N2多站淋巴结转移者术后复发是N2单站淋巴结转移者的3．34倍；隆突下淋巴结转移者术后复发风险是未转移者的2．11倍。结论ⅢA—N2期NSCLC患者主要以转移性复发为主，影响术后复发的重要危险因素包括Lvl、N2阳性淋巴结站数、N2阳性淋巴结数量和隆突下淋巴结是否转移。

Objective To explore the postoperative recurrence patterns in the patients undergoing potentially curative resection of stage Ⅲ A-N2 non-small cell lung cancer （NSCLC）. Methods A total of 63 patients underwent curative operation from September 2004 to December 2008 at Peking University First Hospital and were pathologically diagnosed as stage ⅢA-N2 NSCLC. Their clinical data were retrospectively reviewed. The follow-ups were conducted to detect the recurrent lesions. The recurrence rates at Year 2 -3 were calculated by the Kaplan-Meier method while the Cox proportional hazard model was used to assess the risk factors associated with recurrence. Results The 2 and 3-year recurrence rate was 46. 6% and 57. 3% respectively. Only one patient experienced local failure. However, the predominant recurrence pattern was distant failure （27/28）. As demonstrated by the univariate Cox regression analysis, 4 significant factors associated with recurrence and the arm of lymphatic or vascular invasion （ LVI ） , number of positive N2 station 〉 1, number of positive node 〉 3 and involvement of subcarinal lymph nodes were found to increase the risks of failure （ P 〈 0. 05 ）. Conclusion Distant failure is the predominant pattern of postoperative recurrence in the patients of stage ⅢA-N2 NSCLC. In addition to LVI, the level of positive N2 station, the number of positive N2 node and the involvement of subcarinal lymph nodes are associated with the postoperative risk of recurrence.