IIIa期非小细胞肺癌术后生存分析

Postoperative Survival of Patients with Stage IIIa Non-small Cell Lung Cancer

背景与目的 IIIa期非小细胞肺癌(non-small cell lung cancer,NSCLC)目前多提倡手术治疗,术后患者的生存情况则受多种因素的影响。该研究对IIIa期NSCLC手术患者的预后影响因素进行了统计分析。方法回顾性分析2002年3月-2012年10月北京协和医院收治的术后病理确诊为IIIa期NSCLC的患者151例。按照N分期的不同分为T4N0/T3-4N1M0和T1-3N2M0期两组。采用Kaplan-Meier方法比较生存期(overall survival,OS)和无进展生存期(progression free survival,PFS),进行OS和PFS影响因素的单因素分析,并绘制生存曲线。采用Cox比例风险模型进行多因素分析。以P<0.05认为差异有统计学意义。结果 151例IIIa期NSCLC患者中有T4N0/T3-4N1M0期43例和T1-3N2M0期108例。全组患者的中位OS和PFS分别为38.9月和19.2月。T4N0/T3-4N1M0和T1-3N2M0期的中位OS分别为48.7月和38.9月,中位PFS分别为14.9月和19.8月。两组OS和PFS的差异均无统计学意义(P>0.05)。单因素和多因素分析均显示术后化疗对IIIa期手术患者OS的影响有统计学意义(P=0.001),肿瘤家族史对其PFS的影响有统计学意义(P<0.05)。肿瘤最大径只在单因素分析中对PFS有影响。结论术后化疗可以改善IIIa期NSCLC手术患者的生存期,术后放疗对生存期无改善作用。

Background and objective At present, surgery is advocated for stage IIIa non-small cell lung cancer （NSCLC）, and the survival of them is determined by many factors. hTe aim of this study is to analyze the inlfuencing factors of prognosis for stage IIIa surgical patients. Methods Between March 2002 and October 2012, 151 surgical cases that have postoperative pathological ifnding of stage IIIa NSCLC with completed followed-up data were received in the Peking Union Medical College Hospital. According to different N stages, 151 patients were divided into T4N0/T3-4N1M0 and T1-3N2M0 stages. Kaplan-Meier survival method was used to calculate the overall survival （OS） and progression-free survival （PFS）, and to proceed univariate analysis of survival. Cox regression analysis was used to conduct multivariate analysis. A p-value less than 0.05 was evaluated as statistically signiifcant. Results 151 stage IIIa NSCLC patients had 43 stage T4N0/T3-4N1M0 cases and 108 stage T1-3N2M0 cases. hTe median OS and PFS of the whole group were 38.9 and 12.9 months respectively. hTe median OS of stage T4N0/T3-4N1M0 and T1-3N2M0 were 48.7 and 38.9 months. hTe median PFS of them were 14.9 and 19.8 months respectively. hTere were no signiifcant differences of OS and PFS between two groups. Univariate and multivari-ate analysis indicated that postoperative chemotherapy had a signiifcant inlfuence on OS of the surgical patients with stage IIIa NSCLC （P=0.001）, and family history of tumor had a signiifcant inlfuence on PFS （P〈0.05）. hTe maximum diameter of tumor had a signiifcant inlfuence on PFS only in univariate analysis. Conclusion For stage IIIa NSCLC, postoperative chemotherapy can increase OS and PFS, but postoperative radiotherapy have no beneift on them.