胸腔镜肺段切除术治疗早期NSCLC疗效及预后因素分析

Treatment efficacy and prognostic factors related to thoracoscopic segmentectomy for early NSCLC

目的:探讨胸腔镜肺段切除术治疗早期非小细胞肺癌(NSCLC)的疗效及预后因素分析。方法:选择2018年1月至2019年12月在广东省第二人民医院行胸腔镜肺段切除术治疗的63例NSCLC患者作为研究对象,收集基线资料和手术情况,检测手术前后肺功能指标第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气流量(PEF);评估术后3年总生存率(OS)和无瘤生存率;采用多因素Logistic回归分析影响患者生存的独立因素。结果:术后1、2周,患者肺功能指标FVC、FEV1、PEF低于术前(P<0.05);术后4周,患者肺功能指标FVC、FEV1、PEF恢复,与术前比较,差异无统计学意义(P>0.05)。63例患者中1例于术后20个月失访,1例于术后23个月拒绝随访,排除上述2例病例,最终获得61例患者的完整随访资料,随访成功率96.83%。61例患者中14例死亡,累计死亡率22.95%,累计OS 77.05%,无瘤生存率68.85%(42/61);总平均生存时间为42.02个月,95%CI(25.47,53.05)个月。年龄、病理分型、临床分期、淋巴结转移是患者术后36个月OS降低的危险因素,体质指数是影响患者术后36个月OS的独立影响因素(P<0.05)。结论:胸腔镜肺段切除术治疗早期NSCLC的疗效和安全性均较高,可迅速恢复术后肺功能指标,3年生存率高;年龄、体质指数、病理分型、临床分期、淋巴结转移是患者术后3年生存率的独立影响因素,应对高危因素患者加强关注,以期最大限度提高其生存率。

Objective:To investigate the treatment efficacy and prognostic factors related to thoracoscopic segmentectomy in early non-small cell lung cancer(NSCLC).Methods:Sixty-three NSCLC patients undergoing thoracoscopic segmentectomy at Guangdong Second Provincial People s Hospital between January 2018 and December 2019 were enrolled.The data at baseline and the surgery were recorded.Before and after surgery,lung function parameters,including the forced expiratory volume in one second(FEV1),forced vital capacity(FVC),and peak expiratory flow(PEF),were measured.The 3-year overall survival(OS)and tumor-free survival after surgery were evaluated.Multivariate Logistic regression was used to determine the independent factors affecting patient survival.Results:At one or two weeks after surgery,the patients showed reductions in the lung function parameters FVC,FEV1 and PEF from baseline(P<0.05).At four weeks after the operation,the patients experienced recovery in lung function parameters FVC,FEV1,and PEF which did not differed significantly from baseline(P>0.05).One of the 63 patients lost to follow-up at 20 months after surgery,and another declined follow-up at 23 months after surgery.After exclusion of these two cases,complete data of follow-up were finally obtained from 61 patients,accounting for a rate of successful follow-up being 96.83%.Fourteen of the 61 patients deceased with a cumulative mortality of 22.95%,a cumulative OS of 77.05%,and a tumor-free survival of 68.85%(42/61).The mean length of overall survival was 42.02[95%CI(25.47,53.05)]months.Patient age,pathological type,clinical staging,and lymph node metastasis were risk factors for lower OS at 36 months after surgery,and body mass index was an independent factor affecting OS at 36 months after surgery(P<0.05).Conclusion:Thoracoscopic segmentectomy offers fairly high efficacy and safety in early NSCLC,leading to quick recovery of postoperative lung function parameters,and a high rate of 3-year survival.Patient age,body mass index,pathological type,clinical staging and lymph node metastasis are independent factors affecting the survival rate of patients at three years after surgery.Patients at high-risk should be followed up closely so as to maximize the survival rate.