老年非小细胞性肺癌胸腔镜解剖性肺切除术远期预后及危险因素分析

Long-term prognosis and risk factors of thoracoscopic anatomical pneumonectomy in elderly patients with non-small cell lung cancer

目的比较单孔胸腔镜下肺段切除术和肺叶切除术治疗老年早期非小细胞性肺癌(NSCLC)的预后情况,并探讨影响预后的相关危险因素。方法回顾性分析我院2015年1月至2019年6月间行单孔胸腔镜下解剖性肺切除手术治疗的老年NSCLC患者150例临床资料,按照手术方式不同分为肺段切除组(n=62)和肺叶切除组(n=88),比较两种手术方式下患者的3年生存率和无进展生存期的差异。使用Cox比例风险回归模型分析影响无进展生存期的独立危险因素。结果肺段切除组和肺叶切除组的3年生存率分别为93.5%和95.5%,差异无统计学意义(P=0.608)。肺段切除组和肺叶切除组的无进展生存时间分别为(28.4±7.6)个月和(35.4±7.0)个月,组间比较差异有统计学意义(P=0.045)。Cox回归分析显示年龄(HR=9.999,95%CI:2.047~48.845,P=0.004)、肿瘤大小(HR=4.371,95%CI:1.322~14.454,P=0.016)、手术方式(HR=0.021,95%CI:0.003~0.132,P<0.001)、切除淋巴结数量(HR=4.059,95%CI:1.052~15.661,P=0.042)是胸腔镜术后无进展生存期独立影响因素。结论老年NSCLC患者行单孔胸腔镜肺段切除术和肺叶切除术均有着较好的临床疗效,两种手术方式的3年生存率无差异,但肺叶切除术的无进展生存期优于肺段切除术,而高龄、肿瘤直径较大、切除淋巴结数目较少是影响无进展生存期的独立危险因素。

Objective To compare the prognosis of single-hole thoracoscopic segmental resection and lobectomy in the treatment of early patients with non-small cell lung cancer(NSCLC)in the elderly,and to explore the related risk factors affecting the prognosis.Methods The clinical data of 150 elderly NSCLC patients who underwent single-hole thoracoscopic anatomical pneumonectomy from January 2015 to June 2019 in our hospital were retrospectively analyzed.They were divided into a segmental pneumonectomy group(n=62)and a lobectomy group(n=88)according to different surgical methods.The differences in the 3-year survival rate and progression-free survival period between the two surgical methods were compared.Cox proportional hazards regression model was used to analyze independent risk factors affecting progression-free survival.Results The 3-year survival rates of the segmental resection group and lobectomy group were 93.5%and 95.5%,respectively,with no significant difference(P=0.608).The progression-free survival time of the segmental resection group and the lobectomy group were(28.4±7.6)months and(35.4±7.0)months,respectively,and the difference between the groups was statistically significant(P=0.045).Cox regression analysis showed that age(HR=9.999,95%CI:2.047~8.845,P=0.004),tumor size(HR=4.371,95%CI:1.322~14.454,P=0.016),surgical method(HR=0.021,95%CI:0.003~0.132,P<0.001),and the number of lymph nodes removed(HR=4.059,95%CI:1.052~15.661,P=0.042)were independent influencing factors on the progression-free survival after thoracoscopic surgery.Conclusion Single-hole thoracoscopic segmental pneumonectomy and lobectomy in elderly patients with NSCLC have good clinical efficacy.There is no difference in the 3-year survival rate between the two surgical methods,but the progression-free survival of lobectomy is better than that of segmental pneumonectomy,while old age,large tumor diameter and less number of lymph nodes removed are independent risk factors affecting progression-free survival.