扩大N1区淋巴结清扫对Ⅱ~ⅢA期非小细胞肺癌患者远期疗效和预后的影响

Impact of expanded N1 lymph node dissection on the long-term efficacy and prognosis of stage Ⅱ-ⅢA non-small cell lung cancer patients

目的探讨扩大N1区淋巴结清扫对Ⅱ~ⅢA期非小细胞肺癌患者远期疗效和预后的影响。方法选取2019年1月至2021年12月河南省人民医院收治的310例Ⅱ~ⅢA期非小细胞肺癌患者作为研究对象, 根据是否在标准化肺癌根治术中扩大N1区淋巴结清扫将患者分为对照组和干预组。术后进行铂类为主的二联辅助化疗4个疗程。随访24个月, 分析两组患者局部复发、无疾病进展生存时间、手术时间、失血量、手术并发症等指标差异。局部复发率采用χ2检验;计量数据比较采用t检验, 生存时间比较采用Logrank检验。结果对照组患者N1区淋巴结清扫数量[(41.17±7.42)个]明显低于干预组患者淋巴结数量[(54.96±7.97)个], 差异有统计学意义(t=14.940, P<0.05)。对照组患者局部发生率(30/139, 21.58%)明显高于干预组患者(12/139, 8.63%), 差异有统计学意义(χ2=6.587, P<0.05)。对照组患者无疾病进展生存时间(9.15个月)明显低于干预组患者(6.14个月), 差异有统计学意义(Logrank=4.581, P<0.05)。对照组和干预组患者手术时间[(143.50±15.15)、(140.37±11.95) min]比较, 差异无统计学意义(t=1.912, P>0.05)。对照组和干预组患者失血量[(115.71±23.85)、(114.17±16.87) ml]比较, 差异无统计学意义(t=0.618, P>0.05)。两组患者并发症发生率比较[12.26%(19/155)和12.90%(20/155), χ2=0.018, P>0.05], 差异无统计学意义。结论扩大N1区淋巴结清扫可显著降低Ⅱ~ⅢA期非小细胞肺癌患者局部复发率, 延长无疾病进展生存时间。

Objective To explore the impact of expanded N1 lymph node dissection on the long-term efficacy and prognosis of stageⅡ-ⅢA non-small cell lung cancer(NSCLC)patients.Methods Totally,310 patients with stageⅡ-ⅢA NSCLC admitted to our hospital from January 2019 to December 2021 were selected as the study subjects.The patients were divided into a control group and an intervention group based on whether expanded N1 lymph node dissection was performed during standardized radical lung cancer surgery.A total of 4 courses of platinum were given based dual adjuvant chemotherapy after surgery.The patients were followed up for 24 months and the differences in indicators such as local recurrence,disease-free survival time,operating time,blood loss,and surgical complications were analyzed between the two groups.The local recurrence rate was tested using chi square test.The t-test was used for comparison of measurement data,nd the Logrank test was used for comparison of survival time.Results The number of lymph node dissection in the N1 area of the control group[(41.17±7.42)]was significantly less than that in the intervention group[(54.96±7.97),t=14.940,P<0.05].The local incidence rate in the control group(30/139,21.58%)was significantly higher than that in the intervention group(12/139,8.63%,χ2=6.587,P<0.05).The disease progression free survival time(9.15 months)in the control group was significantly shorter than that in the intervention group(6.14 months)(Logrank=4.581,P<0.05).There was no statistically significant difference in the operating time between the control group and the intervention group[(143.50±15.15)min vs.(140.37±11.95)min,t=1.912,P>0.05].There was no statistically significant difference in blood loss between the control group and the intervention group[(115.71±23.85)vs.(114.17±16.87)ml,t=0.618,P>0.05].There was no statistically significant difference in the incidence of complications between the two groups There was no statistically significant difference in the incidence of complications between the two groups of patients[12.26%(19/155)and 12.90%(20/155),χ2=0.018,P>0.05].Conclusion Expanded lymph node dissection in the N1 region can significantly reduce the local recurrence rate and prolong the progression free survival time of stageⅡ-ⅢA NSCLC patients,which is of great significance for improving patient survival.