直接跨叶侵犯的非小细胞肺癌患者T分期及手术方式的探讨

T-stage and surgical treatment of non-small cell lung cancer directly invading an adj acent lobe

目的：分析直接跨叶侵犯的非小细胞肺癌（NSCLC）患者预后及不同术式对患者的影响，为更合理地对其进行 T 分期和最佳术式的选择提供线索。方法回顾性分析了直接跨叶侵犯的NSCLC 患者的临床资料。运用 Kaplan-Meier 生存分析等方法，对各组生存率及无进展生存期等进行了比较。同时对采取不同术式的跨叶侵犯患者手术前、后肺功能的变化及并发症发生率进行了对比。结果跨叶侵犯组、局限单叶 T2组及局限单叶 T3组的5年生存率分别为29.39%、46.90%、27.11%，中位生存期分别为29、52、34个月。跨叶侵犯 T2a 组生存率与局限单叶 T2b 组相似，而低于局限单叶 T2a 组（P =0.029）。跨叶侵犯 T2b 组与跨叶侵犯 T3组的生存率接近，且与局限单叶 T3组相比差异均无统计学意义。单叶＋楔形切除组在术后肺功能及呼吸系统并发症方面较双肺或全肺切除组明显占优。结论出现跨叶侵犯应对肿瘤的 T 分期予以升期。由于对呼吸功能影响较小且未增加复发或转移风险，单叶＋楔形切除术是上述患者一种安全可行的手术方式。

Objective To determine the T-stage of non-small cell lung cancer with adjacent lobe invasion and evaluate the respiratory function changes of the patients undergoing different surgeries. Methods We evaluated patients with NSCLC who were pathologically confirmed as direct adjacent lobe invasion in Panzhihua municipal central hospital lately.Kaplan-Meier method was used to calculate the overall survival and progression free survival.Log-Rank test was used to compare the postoperative survival among these groups.Postoperative pulmonary functions and complications were compared among the patients as well.Results Five-year survival rate and median survival time in adjacent lobe invasion group,single-lobe invasion T2 and T3 group were 29.39% and 29 months,46.90% and 52 months, 27.1 1% and 34 months respectively.The survival of adjacent lobe invasion T2a subgroup was similar with single-lobe invasion T2b subgroup,lower than single-lobe invasion T2a subgroup （P = 0.029）.No statistical difference was detected between adjacent lobe invasion T2b subgroup and adjacent lobe invasion T3 subgroup which close to the survival rate of single-lobe invasion T3 subgroup.In addition,postoperative FEV1 % （P =0.041）had reached statistical significance when evaluate the postoperative rehabilitation of patients undergoing different surgeries.Conclusions T-stage should be revised as soon as the adjacent lobe invasion is confirmed.Our results suggest that lobectomy plus wedge resection could be considered as a feasible surgical option according to the better functional results and similar oncological outcome compared with bilobectomy or pneumonectomy.