单站N2和多站N2淋巴结转移的ⅢA期非小细胞肺癌患者的生存分析

Prognostic significance of single and multiple station N2 in patients with surgically resected Stage N2-ⅢA Non-small Cell Lung Cancer

目的探讨ⅢA(N2)期非小细胞肺癌(NSCLC)患者中单站N2和多站N2术后远期生存的差异。方法 2010-2016年50例入选的ⅢA(N2)期NSCLC患者。分析临床因素对ⅢA(N2)期患者生存的影响;比较不同N2状态的生存差异及影响因素。结果全组5生存率为35%,中位生存时间38个月。单因素分析显示单站N2者(n=34)5年生存率为43.6%,多站N2者(n=16)为24.8%(P=0.01)。Ⅲa1/a2期(n=36)5年生存率为41.7%,Ⅲa3/a4期(n=14)为23.4%(P=0.03)。多因素分析显示单站N2转移(HR=0.724,95%CI:0.636~0.891,P=0.001);Ⅲa1+a2期(HR=0.575,95%CI:0.225~0.963,P=0.005)是N2-ⅢA期患者术后远期生存较好的独立预后因素。结论ⅢA(N2)期NSCLC中单站N2、Ⅲa1+a2期预后好于多站N2、Ⅲa3/a4期。单站N2、Ⅲa1+a2期是患者术后远期生存较好的独立因素。

Objective We retrospectively analysed the survival rate of 50 patients who were diagnosed with stage N2-m a NSCLC and treated with surgery. We explored their prognostic factors. Methods Clinical data of 50 cases with N2-m a NSCLC admitted from January 2010 to January 2016 was retrospectively reviewed. We retrospectively analysed the impact of the clinical data on survival rate of patients with stage N2- Ⅲ a. Afterwards, we compared the survival rate between patients with different N2 status. Results The 5-year survival rate of all the 50 cases was 35%, with a median survival time of 38 months. Univariate analysis showed the 5-year survival rates in patients with single and multiple station N2 metastasis were 43.6% and 24.8%, respectively （P =0.01 ）. The 5-year survival rates in patients with stage Ⅲ a1/a2 and stag Ⅲ a3/a4 were 41.7% and 23.4%, respectively （P = 0.03）. Multivariate analysis demonstrated that only single station N2 （HR = 0.724, 95% CI： 0.636 - 0.891, P = 0.001 ） Ⅲ a1/a2 （HR = 0.575, 95% CI： 0.225 ~ 0.963, P = 0.005） were independent prognostic factors for stage N2-m a lung cancer patients. Conclusion These findings indicated that with single-station N2 metastasis were better than those with multi-station N2 metastasis. Patients with Ⅲ al/a2 had a better survival compared with stage m a3/a4 patients. Besides, single-station N2 metastasis and Ⅲa1 ＋a2 status are the independent prognostic factor.