Ⅲ-pN2期非小细胞肺癌术后复发模式分析:对术后放疗临床靶区体积范围的建议

Analysis of Postoperative Local Recurrence Patterns of Stage Ⅲ-pN2 NonSmall Cell Lung Cancer: A Reference for Postoperative Radiotherapy Clinical Target Volume

目的:本研究旨在分析III-pN2期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后化疗后局部复发的高危因素,并依据术后复发部位及频率为该类肺癌术后放疗(postoperation radiotherapy,PORT)临床靶区体积(clinical target volume,CTV)范围提供参考。方法:回顾性分析2013年1月至2016年12月我院105例术后病理证实为III-pN2期NSCLC患者的临床资料,分析其局部复发的影响因素,并分析以不同肺叶原发灶及病理证实不同阳性淋巴结区域(lymph node station,LNs)为基础术后化疗后的局部复发模式。结果:多因素分析显示pN2站数(P=0.004)、分化程度(P=0.012)、LN阳性率>1/3(P=0.030)及年龄>55岁(P=0.049)是局部复发的独立预测因素。本研究中50例患者术后出现局部复发(首发或累积),最常见的复发部位依次为同侧肺门(21.0%)、残端(20.0%)、LNs4R(19.0%)、LNs4L(18.1%)、LNs7(15.2%);不同肺叶局部复发情况不同,大部分右侧肿瘤以同侧复发为主,而左侧肿瘤多累及对侧纵隔,尤其是LNs4R(15.8%)。大多数患者(76.0%)局部复发时伴远处转移。结论:建议考虑IIIpN2 NSCLC患者的PORT CTV时应根据原发肿瘤所处左、右侧不同肺叶来设计。除支气管残端、同侧肺门及阳性LNs外,左肺PORT CTV常规包括LNs4、LNs7、LNs5及LNs6,右肺PORT CTV常规包括LNs4R及LNs7。

Objective:This study aims to analyze high risk factors for local recurrence after chemotherapy in stage III-pN2 non-small cell lung cancer(NSCLC)patients,and provide a reference for postoperative radiotherapy(PORT)clinical target volume(CTV)for this type of lung cancer based on sites and frequency of postoperative recurrence.Methods:Clini-cal data of 105 patients with stage III-pN2 NSCLC from January 2013 to December 2016 were analyzed retrospectively.Fac-tors affecting local recurrence were illustrated.Sites of local recurrence after chemotherapy on the basis of primary lesions of different lobes and different positive lymph node regions were described.Results:Multivariate analysis showed that short lo-cal recurrence-free survival was correlated with multiple-station pN2(P=0.004),poorly-differentiated tumors(P=0.012),