新辅助化疗后胸腔镜手术对Ⅲa-N2期NSCLC患者血清CYFRA21-1、NSE的影响

Influence of thoracoscopic surgery after neoadjuvant chemotherapy on serum levels of CYFRA21-1 and NSE in patients with newly diagnosed stage Ⅲa-N2 NSCLC

目的:探讨新辅助化疗后胸腔镜手术对初诊Ⅲa-N2期非小细胞肺癌(NSCLC)患者血清细胞角蛋白19片段抗原(CYFRA21-1)和神经元特异性烯醇化酶(NSE)表达水平的影响。方法:选择初诊Ⅲa-N2期NSCLC患者82例,随机分为观察组(n=41)与对照组(n=41)。观察组术前新辅助化疗后实施胸腔镜手术,对照组直接行胸腔镜手术。比较两组手术情况、治疗前后血清CYFRA21-1、NSE水平及临床预后。结果:两组淋巴结清扫数、手术时间、术后并发症率比较,差异无统计学意义(P> 0. 05);观察组手术切除率显著高于对照组(95. 12%vs 78. 05%,P <0. 05),术中出血量显著短于对照组(P <0. 05);治疗后观察组的血清CYFRA21-1、NSE水平显著低于对照组(P <0. 05);两组1年复发转移率(20. 59%vs 33. 33%,P> 0. 05)、1年生存率比较无明显差异(88. 24%vs 76. 67%,P> 0. 05),观察组3、5年复发转移率显著低于对照组(35. 29%vs 56. 67%、58. 82%vs 86. 67%,P <0. 05),3、5年生存率较对照组显著提高(67. 65%vs 53. 33%、41. 18%vs 20. 00%,P <0. 05)。结论:新辅助化疗后胸腔镜手术能够提高初诊Ⅲa-N2期NSCLC患者的手术切除率及近期疗效,不增加术后并发症,且能降低血清CYFRA21-1、NSE水平。

Objective： To investigate the influence of thoracoscopic surgery after neoadjuvant chemotherapy on serum levels of cytokeratin 19 fragment antigen（ CYFRA21-1） and neuron-specific enolase（ NSE） in patients with newly diagnosed stage Ⅲa-N2 non-small cell lung cancer（ NSCLC）. Methods： 82 cases of patients with newly diagnosed stage Ⅲa-N2 NSCLC were randomly divided into observation group（ n = 41） and control group（ n =41）. The observation group underwent thoracoscopic surgery after preoperative neoadjuvant chemotherapy,the control group underwent thoracoscopic surgery. The surgical conditions and clinical outcomes of the two groups were compared. Serum CYFRA21-1 and NSE levels were measured before and after treatment. Results： There was no significant difference in the number of lymph node dissections,operation time and postoperative complications between the two groups（ P〉0. 05）,the surgical resection rate in the observation group was significantly higher than that in the control group（ 95. 12% vs 78. 05%,P〈0. 05）,and the amount of blood loss in the observation group was significantly shorter than that in the control group（ P〈0. 05）. The serum levels of CYFRA21-1 and NSE in the observation group after treatment were significantly lower than those in the control group（ P〈0. 05）.There was no significant difference in 1-year recurrence metastasis rate（ 20. 59% vs 33. 33%,P〉0. 05） and survival rates between the two groups（ 88. 24% vs 76. 67%,P〈0. 05）,while the 3-and 5-year recurrence metastasis rates in the observation group were significantly lower than those in the control group（ 35. 29% vs56. 67%,58. 82% vs 86. 67%; P〈0. 05）,the 3-and 5-year survival rates in the observation group were significantly higher than those in the control group（ 67. 65% vs 53. 33%,41. 18% vs 20. 00%; P〈0. 05）.Conclusion： Thoracoscopic surgery after neoadjuvant chemotherapy can significantly improve the resection rate and therapeutic effect without increase of complications,which can reduce serum CYFRA21-1,NSE levels.