淋巴结清扫个数对T_(1a)N_0期非小细胞肺癌预后的影响

Effect of lymph node dissection on prognosis of stage T_(1a)N_0 non-small cell lung cancer

目的探讨淋巴结清扫个数对T_(1a)N_0期非小细胞肺癌预后的影响。方法提取美国国家癌症研究所开发的监测、流行病学和结果(SEER)数据库1998至2011年接受手术治疗的T_(1a)N_0期(肿瘤直径≤10mm且无淋巴结转移)非小细胞肺癌患者的临床资料。按照手术淋巴结清扫个数分为3组,即A(0个)、B(1~5个)和C(≥6个)组。随访截止时间为2011年,利用Kaplan-Meier法和Cox比例风险模型分析淋巴结清扫个数对非小细胞肺癌患者预后的影响。结果不同年龄、病理类型、手术范围、诊断年份的非小细胞肺癌患者淋巴结清扫个数比较,差异均有统计学意义(均P<0.05)。A、B、C组患者3年生存率分别为87.1%、89.4%和92.2%,5年生存率分别为77.3%、83.9%和86.7%,10年生存率分别为66.5%、73.1%和77.8%。C组患者预后优于A组(P<0.05);而B与A、C组预后比较,差异均无统计学意义(均P>0.05)。经Cox比例风险模型分析,性别、分化程度是影响T_(1a)N_0期非小细胞肺癌患者预后的独立相关因素(均P<0.05);进一步作亚组分析,发现女性亚组中,A、B、C组患者预后比较,差异无统计学意义(P>0.05);而男性亚组中,C组患者明显优于A、B组(均P<0.05)。结论对于T_(1a)N_0期非小细胞肺癌患者,淋巴结清扫可改善男性患者的预后,但对女性患者意义不大。

Objective To investigate the effect of lymph node dissection on the prognosis of T1aN0 non-small cell lung cancer（NSCLC）. Methods Clinical data of patients with T1aN0 NSCLC receiving surgical treatment from 1998 to 2011 were extracted from the Monitoring, Epidemiology and Outcomes（SEER） database developed by the National Cancer Institute.According to the number of lymph node dissected, patients were divided into 3 groups： A（0）, B（1-5） and C（≥6） groups. The patients were followed up until 2011. The Kaplan-Meier method and the Cox proportional hazard model were used to analyze the effect of lymph node dissection on the prognosis of NSCLC patients. Results Total 973 patients with stage T1aN0 non-small cell lung cancer were included in the analysis, including 397 males and 576 females aged 23-80 years. There were significant differences in number of lymph node dissected among patients with different ages, pathological types, surgical scope and diagnosis years（P〈0.05）. The 3-year survival rates of patients in groups A, B, and C were 87.1%, 89.4%, and 92.2%, respectively. The 5-year survival rates were 77.3%, 83.9%, and 86.7%, respectively. The 10-year survival rates were 66.5%, 73.1%, and 77.8%,respectively. The prognosis of patients in group C was better than that in group A（P〈0.05）. There was no significant difference in the prognosis between groups B and A, between groups B and C（P〈0.05）. Cox proportional hazards model showed that gender and degree of differentiation were independent factors affecting the prognosis of patients（P〈0.05）. Further stratification by gender showed that the prognosis for male patients in group C was significantly better than that in groups B and C（both P〈0.05）, but not for female patients（P〈0.05）. Conclusion In patients with T1aN0 non-small cell lung cancer, lymph node dissection can improve the prognosis of male patients, but it is of little significance for female patients.