全肺切除术后辅助化疗的5年生存分析

An analysis of 5-year survival after pneumonectomy and adjuvant chemotherapy in lung cancer

背景与目的:全肺切除术能有效提高中晚期肺癌患者的切除率,术后辅助化疗也已经成为肺叶切除术后肺癌患者的一种重要的治疗手段,但全肺切除术后辅助化疗是否能提高肺癌患者的生存获益目前仍有争议,本研究通过对全肺切除术后辅助化疗患者的5年生存分析,评价其疗效及临床意义。方法:回顾分析1998年1月—2006年12月于上海交通大学附属仁济医院胸外科接受全肺切除术的67例肺癌患者的临床资料,以是否按时完成术后辅助化疗分为化疗组(n=30)和非化疗组(n=37),随访其5年生存状况,应用SAS9.13统计学软件包处理数据,判断其1、3、5年的生存率差异是否有统计学意义。在大组分析的结果中,以病理类型、临床分期、N2组别、手术侧、手术方法等可能影响长期生存结果的因素进行亚组分析。结果:两组基本参数一致,全肺切除术后化疗组1、3、5年生存率分别为79.76%、53.58%、34.44%,非化疗组分别为59.46%、32.43%和21.62%。两组比较3年生存率差异有统计学意义(P<0.05)。亚组分析显示在非小细胞肺癌组及鳞癌组中,化疗组3年生存率分别为70.30%、75.41%,非化疗组分别为37.50%、40.00%,差异有统计学意义(P<0.05)。Ⅲa组中,化疗组1年生存率为93.55%,非化疗组为50.00%,差异有统计学意义(P<0.05)。各亚组中,化疗组和非化疗组的长期生存率差异均无统计学意义。结论:全肺切除术后辅助化疗能提高肺癌患者的早期生存率,但对于提高长期生存率作用有限。为改善长期生存状况,对合适患者进行巩固化疗,以及放化疗联合应用可能是一种有效的方法。

Background and purpose： The resection rate may be improved by pneumonectomy in late stage cases of lung cancer, and adjuvant chemotherapy is one of the important treatment methods after lobectomy, however, whether the lung cancer patients may benefit from adjuvant chemotherapy after pneumonectomy is still controversial currently. This study was to observe 5-year survival of the cases who had been performed adjuvant chemotherapy after pneumonectomy, and evaluate the efficacy of treatment. Methods： From Jan. 1998 to Dec.2006, 67 patients underwent pneumonectomy for lung cancer in our hospital, they were divided into two groups, the adjuvant chemotherapy group received four cycles chemotherapy （n=30）, while the another group did not receive chemotherapy after operation （n=37）. Patients were followed up for 5-year survival rate, the short- and long-term treatment efficacy were analyzed by SAS 9.13. Pathological type, TNM stage, side of pneumonectomy and other factors which may influence the survival rate are included in subgroup analysis. Results： The 1-, 3-, and 5-year survival rates were 79.76%, 53.58%, and 34.44% in adjuvant chemotherapy group, while 59.46%, 32.43% and 21.62% in group without adjuvant chemotherapy. The short- term survival rate （3-year） was significantly higher in chemotherapy group than in control group （P〈0.05）, while the long-term survival rate had no significant difference between the two groups （P〉0.05）. Squamous carcinoma group, and IIIa group have the positive result in subgroup analysis. Conclusion： The adjuvant chemotherapy after pneumonectomy may improve short-term survival rate in lung cancer.