纵隔淋巴结包膜外软组织受侵对ⅢA—N2期NSCLC术后放疗效果的预测作用

Extracapsular extension in prediction of the efficacy of postoperative radiotherapy in the treatment of stage ⅢA—N2 non-small cell lung cancer

目的 探讨淋巴结包膜外软组织受侵（ECE）对ⅢA—N2期NSCLC术后放疗效果的预测价值.方法 共纳入2008—2009年220例术后ⅢA—N2期NSCLC患者,均接受了术后化疗,其中43例接受了术后放疗;按ECE（＋）和ECE（-）分成两组,然后依照术后单纯化疗（non-PORT）和术后同步放化疗（PORT）行亚组分析.采用Kaplan-Meier法计算PFS、OS并Logrank检验和单因素预后分析,Cox模型多因素预后分析.结果 单因素分析显示ECE（-）组PFS、OS均优于ECE（＋）组（P=0.000、0.000）;ECE＋组内PORT亚组和non-PORT亚组间PFS、OS均相近（P=0.584、0.723）,ECE（-）组内PORT亚组PFS明显优于non-PORT亚组（P=0.039）,但OS相近（P=0.125）.多因素分析提示ECE是影响ⅢA—N2期非小细胞肺癌PFS和OS的独立预后因素（P=0.001、0.020）.结论 ECE是ⅢA—N2期NSCLC的独立预后因素,它有可能作为ⅢA—N2期NSCLC术后放疗选择的依据.

Objective To investigate the value of extracapsular extension （ ECE） in prediction of the efficacy of postoperative radiotherapy （ PORT） in the treatment of stage ⅢA—N2 non-small cell lung cancer （ NSCLC） . Methods From 2008 to 2009, 220 patients with stage ⅢA—N2 NSCLC who received surgical treatment were enrolled as subjects. All patients received postoperative chemotherapy and 43 out of them received PORT. Those patients were divided into ECE （＋） group and ECE （-） group, which were further divided into subgroups according to whether PORT was applied or not. Progression-free survival （ PFS） and overall survival （ OS） rates were calculated using the Kaplan-Meier method and analyzed using log-rank test. Univariate and multivariate prognostic analyses were conducted using the log-rank test and the Cox model, respectively. Results The univariate analysis showed that the ECE （-） group had significantly improved PFS and OS rates than the ECE （＋） group （ P=0. 000, 0. 000） . In the ECE （＋） group, there were no significant differences in PFS or OS rate between the PORT subgroup and the non-PORT subgroup （ P=0. 584, 0. 723） . In the ECE （-） group, the PORT subgroup had a significantly improved PFS rate than the non-PORT subgroup （ P=0. 039） , while there was no significant difference in OS rate between the two subgroups （ P=0. 125） . The multivariate analysis indicated that ECE was an independent prognostic factor for PFS and OS rates in patients with stageⅢA—N2 NSCLC （ P=0. 001, 0. 020） . Conclusions ECE is an independent prognostic factor for stageⅢA—N2 NSCLC and promises to provide a basis for the use of PORT in the treatment of stage ⅢA—N2 NSCLC.