肺叶切除术和局限性切除术对老年Ⅰ期非小细胞肺癌患者的预后影响

Lobectomy and Limited Resection Surgery on the Prognosis of Stage Ⅰ Non-small Cell Lung Cancer

目的研究局限性切除术对老年Ⅰ期NSCLC患者围手术期并发症及远期生存的影响。方法回顾性分析明确诊断为NSCLC并行肺癌切除术(肺叶切除术、局限性切除术)的患者,对其人口学资料及临床病理学资料进行对比分析并绘制生存曲线比较术式对预后的影响。结果肺叶切除术组FEV1为79.27,而局限性切除术组为87.86(P=0.034);肺叶切除术组手术时间较局限性切除术组长(123.6 min vs 81.8 min,P=0.001),且失血量更多(121.07 ml vs68.08 ml,P=0.000),但是肺叶切除术组淋巴结清扫数目多(13.3 vs 2.9,P=0.000);肺叶切除术组与局限性切除术组相比总生存期及无病生存期差异无统计学意义(P=0.494),但是亚组分析显示:当肿瘤直径>2 cm或FEV1>80%时,肺叶切除术患者可以获得更好的无病生存期(P=0.010,P=00.024)。结论对于肿瘤直径<2 cm且(或)心肺功能较差的老年Ⅰ期NSCLC患者,局限性切除术应该是这部分患者的优先选择。

Objective To study the effect of limited resection on perioperative complications and long-term survival of elderly patients with stage I non-small cell lung cancer （NSCLC）. Methods A retrospective analysis of NSCLC patients treated with lung resection （lobectomy ,limited resection3 were conducted ,the demographic data and clinical pathological data were analyzed and survival curves were compared on the prognosis. Results FEV1 was 79.27 in lobectomy group and limited resection group was 87.86 （P = 0.034） ;tobectomy group operation time was longer than limited resection group （ 123.6 min vs 81.8 min, P = 0.001 ） and more blood loss （ 121.07 ml vs 68.08 ml, P = 0. 000 ）, but the lymph node resection was more in lobeetomy group （13.3 vs 2.9 ,P = 0. 000）;The difference was not statistically significant in overall survival and disease-free survival in both Lobeetomy group and limited resection group （ P = 0.494） , but subgroup analysis showed that tumor diameter greater than 2 em or FEVI greater than 80%, lung resection patients can get a better disease-free survival （P = 0. 010 ,P = 0.010 ）. Conclusion Limited resection should be a preferred option for elderly patients with stage I NSCLC with tumor diameter less than 2 cm and （or） with poor cardiac and pulmonary function.