非小细胞肺癌患者术中发现胸膜播散的预后分析

Prognosis of surgery in the treatment of non-small cell lung cancer with unexpected pleural dissemination

目的评估手术切除肿瘤对非小细胞肺癌(NSCLC)伴恶性胸膜播散患者预后的影响。方法收集2011年1月至2015年12月上海市胸科医院NSCLC手术患者的临床资料,将术中意外发现胸膜播散的患者纳入研究。结果通过术中或术后病理学检查,共有160例NSCLC患者被诊断为胸膜播散。71例(44.4%)仅行胸膜结节活检(活检组),89例(55.6%)行原发肿瘤切除术(切除组)。中位无进展生存期(PFS)和总生存期OS)分别为13个月和41个月,3、5年的无进展生存率分别为13.1%和5.7%,总生存率分别为56.0%和28.7%。切除组患者的PFS和OS均明显优于活检组(19个月vs 10个月,P=0.000;48个月vs 33个月,P=0.000)。切除组的3、5年无进展生存率和总生存率均高于活检组(20.8%vs 3.2%,10.8%vs 0;67.8%vs 41.0%,37.7%vs 18.2%)。接受亚肺叶切除术与肺叶切除术患者的生存差异无统计学意义(P=0.34)。单因素和多因素分析结果显示辅助靶向治疗、无恶性胸腔积液、T1/T2期和N0期是独立的预后因素。结论术中诊断为NSCLC伴胸膜播散的患者可通过手术切除原发肿瘤和包括靶向治疗在内的多学科治疗获益。辅助靶向治疗、无恶性胸腔积液、低T分期、低N分期患者的预后较好。在可行的情况下,楔形切除术可能是一个合适的选择,虽然不同手术方式亚组的预后差异无统计学意义,但其创伤更小。

Objective To evaluate the effect of surgical resection on the prognosis of non-small cell lung cancer(NSCLC)patients with malignant pleural dissemination(PD).Methods Clinical data of consecutive patients who underwent surgeries for NSCLC between January 2011 and December 2015 at Shanghai Chest Hospital were collected.The patients who were found unexpected PD intraoperatively were enrolled in this study.Results A total of 160 patients diagnosed with unexpected malignant PD through intraoperatively or postoperatively histological examinations were enrolled in the present study.71(44.4%)patients received pleural nodule biopsy only,and 89(55.6%)received primary tumor resection.The median progression-free survival(PFS)and median overall survival(OS)were respectively 13 months and 41 months.The 3-and 5-year PFS and OS rates for all patients were 13.1%,5.7%and 56.0%,28.7%,respectively.In comparison,patients in the resection group had better PFS(19.0 months vs 10.0 months,P<0.001)and OS(48.0 months vs 33.0 months,P<0.001)than those in the biopsy group.The 3-and 5-year PFS rates of resection group were higher than biopsy group(20.8%vs 3.2%,10.8%vs 0).Similar results were found for OS rates(67.8%vs 41.0%,37.7%vs 18.2%).There was no significant difference in survival between patients with sublobectomy and lobectomy(P=0.34).Univariate and multivariate analyses showed that adjuvant targeted therapy,absence of malignant pleural effusion(MPE),stage T1/T2,and stage N0 were independent prognostic factors.Conclusions NSCLC patients with malignant pleural dissemination diagnosed intraoperatively may be beneficial from surgical resection of main tumor and multidisciplinary adjuvant therapy,especially targeted therapy.Patients with adjuvant targeted therapy,no MPE,lower T stage,and lower N stage may have a better prognosis.Wedge resection tends to be a proper choice if feasible,although there is no difference in survival among different types of resection.