Ⅲ期非小细胞肺癌手术治疗患者预后因素分析

Prognostic factors in surgically managed patients of stage Ⅲ non-small cell lung cancer

目的肺癌是目前全球发病率和死亡率最高的恶性肿瘤之一。其中非小细胞肺癌(non-small cell lung cancer,NSCLC)占绝大多数,部分患者在诊断时已处于Ⅲ期。肺癌的预后较差,本研究拟探讨手术治疗的Ⅲ期NSCLC患者的预后因素。方法回顾性分析2010-01-01-2013-12-31中国医科大学附属第一医院胸外科118例手术治疗的Ⅲ期NSCLC患者临床资料,将可能对患者术后5年生存率产生影响的预后因素进行统计学分析。结果单因素生存分析显示,术后化疗与否(P=0.006)、淋巴结转移总数(P=0.038)、淋巴结总转移率(P=0.009)、N1淋巴结转移数(P=0.009)、N1淋巴结转移率(P=0.011)、N2淋巴结转移数(P=0.011)、N2淋巴结转移组数(P=0.034)、N2淋巴结转移率(P=0.036)、第7组淋巴结转移与否(P=0.001)与患者术后5年生存率相关;多因素生存分析显示,N2淋巴结转移数(P=0.002,RR值2.588,RR值95%CI为1.420~4.718)、第7组淋巴结转移与否(P=0.008,RR值0.467,RR值95%CI为0.267~0.818)是影响患者术后5年生存率的独立预后因素。N2淋巴结转移数>3枚的患者,其死亡风险是≤3枚的2.588倍;第7组淋巴结转移患者的死亡风险是未转移的2.141倍。结论对于手术治疗的Ⅲ期NSCLC患者,如果其淋巴结转移总数>4枚、淋巴结总转移率>50%、N1淋巴结转移数>2枚、N1淋巴结转移率>50%、N2淋巴结转移>3枚以及>3组、N2淋巴结转移率>45%、第7组淋巴结转移、术后未辅以化疗,预后可能不佳。

OBJECTIVE Lung cancer is one of the malignant tumors with the highest morbidity and mortality both in the world and in China. Non small cell lung cancer accounts for the vast majority of it, some patients have been in stage Ⅲ at the time of diagnosis. The prognosis of lung cancer is poor, this research is to investigate the prognostic factors in surgically managed patients of stage Ⅲ nomsmall cell lung cancer. METHODS A retrospective analysis of the clinical da ta of surgically managed 118 cases of stage Ill non small cell lung cancer from the Thoracic Department of the First Affili ated Hospital of China Medical University from 2010 1 1 to 2013-12-31 was conducted, and the prognostic factors that may impact the postoperative 5-year survival rate of the patients were statistically analyzed. RESULTS Univariate surviv al analysis showed that the postoperative chemotherapy（P= 0. 006）, the total, number of metastatic lymph nodes （P=0. 038） ,the total metastatic rate of lymph nodes（P=0. 009） ,the number of metastatic N1 lymph nodes（P=0. 009） ,the metastatic rate of N1 lymph nodes（P= 0.011 ）, the number of metastatic N2 lymph nodes（P = 0.011 ）, the number of group of metastatic N2 lymph nodes（P=0. 034）, the metastatic rate of N2 lymph nodes（P= 0. 036）, the 7th group of lymph nodes were metastatic or not（P = 0. 001） were related to the postoperative 5-year survival rate of the patients;Multivariate survival analysis showed that the number of metastatic N2 lymph nodes（P= 0. 002;RR values：2. 588;the 95% CI of RR value：l. 420-4. 718） ,the 7th group of lymph nodes were metastatic or not（P=0. 008;RR values：0. 467;the 95% CI of RR value：0. 267-0. 818） were independent prognostic factors for the postoperative 5-year survival rate of the patients. The risk of death of the patients whose number of metastatic N2 lymph nodes 〉3 was 2. 588 times to those ≤3,and the risk of death of the patients with the 7th group of lymph nodes metastasis was 2. 141 times to those without metastasis. CONCLUSIONS Surgically managed patients of stage Ⅲ non-small cell lung cancer may have a poor prognosis in the ca- ses of the total number of metastatic lymph nodes 〉4 ,the total metastatic rate of lymph nodes 〉50% ,the number of me- tastatic N1 lymph nodes 〉2 ,the metastatic rate of NI lymph nodes 〉50% ,the number/number of group of metastatic N2 lymph nodes 〉3 ,the metastatic rate of N2 lymph nodes 〉50% ,the 7th group of lymph nodes metastasis and no postoper- ative chemotherapy.