新辅助化疗对ⅢA-N2期非小细胞肺癌淋巴结转移率及预后的影响

Correlation Between Efficacy and Lymph Node Ratio and Prognosis of Neoadjuvant Chemotherapy in StageⅢA-N2 NSCLC

目的探讨ⅢA-N2期非小细胞肺癌(non-small cell lung cancer,NSCLC)新辅助化疗疗效与淋巴结转移率(lymph node ratio,LNR)及预后的关系。方法收集60例采用新辅助化疗后行手术治疗的ⅢA-N2期NSCLC患者临床及随访资料,分析新辅助化疗临床疗效和淋巴结转移情况,比较LNR与新辅助化疗临床疗效,并进行生存分析,研究LNR与预后的关系。结果新辅助化疗客观缓解率(ORR)是53.3%,疾病控制率(DCR)为95.0%,淋巴结阳性患者率为91.2%,LNR为19.3%。临床疗效ORR组与SD组比较,前者具有更低的LNR(P<0.05)。患者术后1、2、3年的总存活率分别为86%、67%、45%,中位总生存期(OS)为35.0个月;术后1、2、3年无进展存活率分别是63%、40%、21%,中位无进展生存期(PFS)为24.0个月。根据LNR分组进行生存分析,结果显示,低LNR患者具有更长的OS和PFS(P<0.05)。单因素分析显示,低LNR患者有更长高的2年总生存期(OS)。多因素分析显示,LNR是预后的独立危险因素(P<0.05)。结论LNR与临床疗效和预后相关,LNR可以预测新辅助化疗的ⅢA-N2期NSCLC患者的预后。

Objective To investigate the correlation between clinical efficacy and prognosis and lymph node ratio of neoadjuvant chemotherapy on stageⅢA-N2 non-small cell lung cancer.Methods A total of 60 patients with stageⅢA-N2 non-small cell lung cancer were collected.Patients were treated with neoadjuvant chemotherapy and surgical treatment.To analyze the clinical efficacy and lymph node metastasis of neoadjuvant chemotherapy,lymph node ratio and the clinical efficacy of neoadjuvant chemotherapy were compared,and survival analysis was carried out to study the relationship between lymph node ratio and prognosis.Results ORR of neoadjuvant chemotherapy was 53.3%.DCR was 95.0%.The rate of patients with positive lymph nodes was 91.2%,and the lymph node ratio(LNR)was 19.3%.The ORR group had lower LNR compared with the SD group(P<0.05).Overall survival rate were 86%,67%and 45%for 1,2 and 3 years after operation,with a median overall survival of 35.0 months.Progression-free survival rate were 63%,40%and 21%for 1,2 and 3 years after operation,with a median progression-free survival of 24.0 months.According to LNR grouping,survival analysis showed that patients with lower LNR had higher OS and PFS(P<0.05).Univariate analysis showed that the patients with lower LNR had a higher OS with 2 years.Multivariate analysis showed that LNR was an independent risk factor for prognosis(P<0.05).Conclusion LNR was associated with clinical efficacy and prognosis,and LNR can predict the prognosis of neoadjuvant chemotherapy on stageⅢA-N2 NSCLC.