非小细胞肺癌的手术治疗

Surgical Treatment of Non-Small Cell Carcinoma of Lung

我院自1960年至1983年24年间住院手术治疗非小细胞肺癌276例,其中鳞癌134例(48.6％),腺癌100例(36.2%)、大细胞癌20例(7.2%)、腺鳞癌3例(1.1％)和未定型癌19例(6.9%)。手术切除180例(包括6例死亡),切除率为65.2％。根治性切除163例中Ⅰ期114例(70％)、Ⅱ期42例(25.7％)和Ⅲ期7例(4.3％)。能评价疗效者157例,其5年生存率为42.5％,10年生存率29.4％。淋巴结无转移的5年生存率为47％,10年为35.4％;有转移的5年生存率为29.4%,10年为15％。Ⅰ期的5年生存率为48.4％,Ⅱ期为23.3％。不同病理类型的预后有较大区别,本组鳞癌的预后优于腺癌。癌瘤位于上叶或下叶对预后影响不明显,以中叶肺癌的预后为最差,手术标本支气管断端肉眼所见正常,但並微镜下见癌细胞者12例,半数术后良好,死于癌者亦未见残端复发癌。

Two hundred and seventy six cases of non-small cell lung cancer (NSCLC) were operated upon during the period 1960-1983 in Tianjin Cancer Hospital, including 134 (48.6%) squamous cell carcinoma, 100 (36.2%) adenocarcinomas, 20 (7.2%) large cell carcinomas, 3 (1.1%) adenosquamous cell carcinomas and 19 (6.9%) unclassified carcinomas. In this series, resection of the lesion was carried out in 180 (65.2%). There were six operation deaths. In 163 cases of curative resection, there were 114 (70%) Stage Ⅰ cases, 42 (25.7%) Stage Ⅱ and 7 (4.3%) Stage Ⅲa. Of tne resected cases that were evaluable, the 5-and 10-year survival rates were 42.5% and 29.4%. The same rates of those cases with negative lymph nodes were 47% and 35.4% respectively, while for those with positive lymph nodes the said rates were 29.4% and 15%. The 5-year survival rate of cases of Stage Ⅰ disease was 48.4%, Stage Ⅱ 23.3%. Significant prognostic variation was seen between pathologic types. Based on our data, the prognosis of squamous cell carcinoma was better than that of adenocarcinoma. The location of cancer, irrespective of being in the upper or lower lobe, imposed no difference in prognosis but that in the middle lobe were unfavorable. Of cases with grossly normal bronchial stump, cancer cells were found microscopically in 12, of which 6 patients died without local recurrence and 6 have been living and well for 3-7 years postoperatively.