术前支气管动脉灌注化疗治疗Ⅲa(N_2)期非小细胞肺癌

Preoperative bronchial artery infusion chemotherapy in the treatment of stage Ⅲa (N_2) non-small cell lung cancer

目的探讨术前支气管动脉灌注(BAI)化疗在Ⅲa(N2)期非小细胞肺癌(NSCLC)治疗中的临床应用价值。方法临床确诊的Ⅲa(N2)期非小细胞肺癌186例,随机分为观察组和对照组,每组93例。观察组患者在接受2次BAI后手术,对照组确诊后直接手术,观察BAI疗效,比较两组患者的手术情况和术后生存率。结果观察组的临床和组织学有效率分别为80.6%和83.9%,TNM分期下降50.53%,不良反应轻微;观察组根治性手术切除率为93.4%,显著高于对照组的72.0%,差异有统计学意义(P<0.05);术中出血量和术后并发症两组间无差别;观察组与对照组1、3、5年生存率分别为97.8%、64.8%、36.3%和89.3%、50.5%、18.3%,两组间差异有显著统计学意义(P<0.01)。结论术前BAI可获得较好的临床和组织学疗效,并能提高Ⅲa(N2)期NSCLC的根治性手术切除率和术后生存率,值得临床推广应用。

Objective To evaluate the clinical application of preoperative bronchial artery infusion（BAI） chemotherapy in treating stage Ⅲa（N2） non-small cell lung cancer. Methods A total of 186 cases with clinically-confirmed non-small cell lung cancer of stage Ⅲa（N2） were enrolled in this study. The patients were randomly and equally divided into observation group（n = 93） and control group（n = 93）. Surgical resection was performed after twice BAI for patients of the observation group, while patients of the control group received operation directly after the diagnosis was made. Therapeutic efficacy of all patients was evaluated. Surgical findings and postoperative survival rate were determined, and the results were compared between the two groups. Results The clinical and histopathological effective rate of the observation group was80.6% and 83.9% respectively, and the TNM staging of the tumor was decreased by 50.5%, the adverse reaction was slight. The radical resection rate of the observation group was 93.4%, which was significantly higher than that of the control group（72.0%）, and the difference was statistically significant（P 0.05）. No statistically significant differences in the intraoperative blood loss and the occurrence of postoperative complications existed between the two groups. The one-, 3-and 5-year survival rates were 97.8%, 64.8%and 36.3% respectively in the observation group, and 89.3%, 50.5% and 18.3% respectively in the control group, and the difference between the two groups was statistically significant（P 0.01）. Conclusion Preoperative BAI has both clinical and histopathological effect. It can improve the radical resection rate as well as the long-term survival rate of stage Ⅲa（N2） non-small cell lung cancer. Therefore, this technique is worthy to be popularized in clinical practice.