局部晚期非小细胞肺癌手术与非手术治疗对比研究

Evaluation on survival in locally advanced non-small cell lung cancer for combined modality therapy with or without operation

目的:局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LANSCLC)放化综合治疗已是共识,手术介入是否致临床获益报道不一,本研究目的是评价手术治疗在综合治疗中的作用。方法:将71例患者据治疗方法分为A组:手术+放化疗组(37例)、B组:放疗+化疗组(34例)。采用Kaplan-Meier和Log-Rank方法进行生存分析,RTOG标准评价急性反应和晚期损伤。结果:中位随访25.5个月,A组中位总生存时间34.6个月,中位无进展生存时间22.3个月,1、2、3年生存率分别为95%、78%、34%;B组近期有效率52.9%,中位总生存时间为16.5个月,1、2、3年生存率分别为76%、28%、10%。A组在生存时间及生存率方面均有明显优势(P<0.05)。化疗不良反应两组相较差异无显著性(P>0.05)。放疗主要不良反应为放射性食管炎及放射性肺炎。手术并未明显增加放疗不良反应发生率及发生程度(P>0.05)。术后患者半数以上2年内出现疾病进展,疾病进展原因主要为远处转移,转移率76.2%。结论:LANSCLC治疗要以综合治疗为主,手术治疗可使生存受益,并延长无进展生存时间以及生存时间,并未增加放化疗不良反应。

Objective：To evaluate the effects of surgery in combined modality therapy for locally advanced non - small cell lung cancer（LANSCLC）. Methods ：Total of 71 cases were divided into two groups：in group A,37 patients received operation plus chemoradiotherapy, in group B, 34 patients received chemoradiotherapy. The Kaplan - Meier method was used to calculate the overall survival rate. Acute and late toxicities were graded according to RTOG radia- tion morbidity scoring criteria. Results： With a median followed- up of 25.5months, in group A, the median overall survival time was 34.6 months ,the median progression- free survival time（PFS） was 22.3months ,and the 1 - ,2 - , 3 - year overall survival rates were 95% ,78% and 34% respectively. In group B ,the response rate（ CR plus PR） was 52.9%, the median overall survival time was 16.5 months, and the 1 -, 2 -, 3 -year survival rates were 76% ,28 % and 10%. Both OS and OSR in group A have advantage（ P 〈 0.05 ）. The major toxicity of radiotherapy were radioactive esophagitis and pneumonia. To the toxicity of chemotherapy in two group, there was no significant difference （P 〉 0.05）. No more than half of patients in group B occurred progression in 2 years. The main reason of progression in group A and B was distant metastasis. The metastatic rate was 76.2%. Conclusion： Survival benefit from surgical treatment can improve survival and prolong progression - free survival time and survival time, and did not increase the toxicity of radiotherapy and chemotherapy.