胸腔镜肺叶切除联合纵隔淋巴结清扫治疗ⅢA期非小细胞肺癌的疗效

Efficacy of video-assisted thoracoscopic surgery lobectomy combined with mediastinal lymph node dissection in treating stageⅢA non-small cell lung cancer

目的探讨胸腔镜肺叶切除(VATS)联合纵隔淋巴结清扫(MLND)治疗ⅢA期非小细胞肺癌(NSCLC)的疗效,以期为NSCLC的临床治疗提供参考。方法回顾性分析空军军医大学第二附属医院2017年6月-2021年12月收治的ⅢA期NSCLC患者的临床资料,采用整群随机抽样法从开胸肺叶切除联合MLND治疗患者中选取57例纳入对照组,从VATS联合MLND治疗患者中选取63例纳入观察组。比较2组患者治疗前及治疗后6个月的血清肿瘤标志物水平、肺功能指标,近期实体瘤疗效,随访2年生存情况以及治疗后6个月内的并发症发生情况。结果观察组患者手术时间长于对照组,淋巴结清扫数目多于对照组,差异均有统计学意义(P<0.05);观察组患者引流时间、住院时间短于对照组,术中出血量小于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者癌胚抗原(CEA)、糖类抗原50(CA50)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)及鳞癌相关抗原(SCC)水平比较,差异均无统计学意义(P>0.05);治疗后6个月,2组患者血清CEA、CA50、CYFRA21-1及SCC水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清最大通气量(MVV)、用力肺活量(FVC)及第1秒用力呼气容积(FEV1)水平比较,差异均无统计学意义(P>0.05);治疗后6个月,2组患者MVV、FVC及FEV1水平均低于治疗前,但观察组均高于对照组,差异均有统计学意义(P<0.05)。治疗后6个月,2组患者疾病控制率(DCR)比较,差异无统计学意义(P>0.05);观察组患者客观缓解率(ORR)高于对照组,差异有统计学意义(P<0.05);不同TNM分期患者的DCR和ORR组间比较,差异均无统计学意义(P>0.05)。2组患者随访2年生存率比较,差异无统计学意义(χ^(2)=2.409,P=0.121);观察组患者无进展生存期(PFS)大于对照组,差异有统计学意义(t=2.842,P=0.005);2组患者总生存时间(OS)比较,差异无统计学意义(t=0.308,P=0.758)。观察组患者治疗后6个月内的并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论针对ⅢA期NSCLC患者,采用VATS联合MLND治疗的近、远期疗效理想,有助于恢复患者肺部功能,且并发症发生风险可控,这为临床治疗提供多种可替代选择,建议临床根据患者实际情况,在医患充分沟通后选择最佳治疗方案。

Objective To explore the efficacy of video-assisted thoracoscopic surgery(VATS)lobectomy combined with mediastinal lymph node dissection(MLND)in treating stageⅢA non-small cell lung cancer(NSCLC),aiming to provide evidence for the clinical treatment of NSCLC patients.Methods A retrospective analysis was conducted on the clinical data of stageⅢA NSCLC patients admitted to the Second Affiliated Hospital of Air Force Medical University from June 2017 to December 2021.A total of 57 patients who underwent open lobectomy combined with MLND were selected as the control group by cluster random sampling,and 63 patients who underwent VATS combined with MLND were selected as the observation group.The serum tumor marker levels,pulmonary function indicators,short-term solid tumor efficacy,2-year follow-up survival,and complications within 6 months after treatment were compared between the two groups.Results The operation time of patients in the observation group was longer than that in the control group,and the number of lymph nodes dissected was more than that in the control group,with both differences being statistically significant(P<0.05).The drainage time and length of hospital stay of patients in the observation group were significantly shorter than those in the control group,and the blood loss was significantly less than that in the control group(P<0.05).Before treatment,no statistically significant differences were noted in the levels of serum carcinoembryonic antigen(CEA),carbohydrate antigen 50(CA50),cytokeratin 19 fragment(CYFRA21-1),and squamous cell carcinoma-related antigen(SCC)between the two groups(P>0.05).The levels of serum CEA,CA50,CYFRA21-1,and SCC in both groups decreased 6 months after treat-ment,and all were lower in the observation group than in the control group,with all differences being statistically significant(P<0.05).Before treatment,no statistically significant differences were observed in the levels of maximum voluntary ventilation(MVV),forced vital capacity(FVC),and forced expiratory volume in 1 second(FEV1)between the two groups(P>0.05).The levels of MVV,FVC,and FEV1 in both groups decreased 6 months after treatment,but all were higher in the observation group than in the control group,with statistically significant differences(P<0.05).Six months after treatment,no statistically significant difference was found in the disease control rate(DCR)between the two groups(P>0.05).The objective response rate(ORR)of patients in the observation group was significantly higher than that in the control group(P<0.05).No statistically significant differences were noted in DCR and ORR between different TNM-stage patients(P>0.05).Besides,no statistically significant difference was noted in the 2-year survival rate between the two groups(χ^(2)=2.409,P=0.121).The progression-free survival(PFS)of patients in the observation group was significantly longer than that in the control group(t=2.842,P=0.005).No statistically significant difference was noted in overall survival time(OS)between the two groups(t=0.308,P=0.758).The incidence of complications within 6 months after treatment in the observation group was significantly lower than that in the control group(P<0.05).Conclusion For stageⅢA NSCLC patients,the short-term and long-term efficacy of VATS combined with MLND treatment is ideal,which helps to restore patients'lung function,and the risk of complications is controllable.This provides various alternative options for clinical treatment.It is recommended that the clinic should choose the best treatment plan based on the actual situation of the patients after full communication with the patients.