非小细胞肺癌同一肺叶内转移的外科疗效及分期探讨

Prognosis and classification for non-small-cell lung cancer with intrapulmonary metastasis in the same lobe as that of the primary tumor

目的 探讨非小细胞肺癌同一肺叶内转移的外科治疗效果并评估其TNM分期。方法 对外科手术切除的 5 1例合并原发灶同一肺叶内转移的非小细胞肺癌病人进行临床回顾性研究。结果 5 1例总体 5年生存率为 2 5 4 % ,无淋巴结转移组 5年生存率为 5 3 8% ,合并淋巴结转移组为 15 8%(P <0 0 5 )。按原发灶T分期 5年生存率分别为T133 3%、T2 4 2 1%、T3 2 0 0 %、T40 (P >0 0 5 )。结论 区域淋巴结转移是影响非小细胞肺癌合并同一肺叶内转移病人的重要预后因素 ,目前的TNM分期没有反映该因素的影响。将原发灶为T3 及T3 以下的此类病人作为T3 分期是恰当的。

Objective: We evaluated the surgical results and TNM classification of the non-small-cell lung cancer with intrapulmonary metastasis in the same lobe as the primary. Methods: Fifty-five patients with primary non-small-cell lung cancer accompanied by metastasis in the same lobe underwent complete pulmonary resection. Results: All these patients categorized as stage IIIb according to the current staging system. The overall 5-year survival rate was 25.4%. The 5-year survival rates were 15.8% in 38 patients with lymphatic involvement and 53.8% in 13 patients without lymphatic involvement (P<0.05). The 5-year survival rates according to the T classification of the primary lesion was 33.3% in T_1, 42.1% in T_2, 20.0% in T_3 and 0 in T_4 (P>0.05), respectively. Although there was no significant difference, the cases in T_4 had no 5-year survivors. Conclusion: The lymph nodes involvement was one of the main prognostic factors for the non-small cell lung cancer with intrapulmonary metastasis in the same lobe. It was suitable to define the T_3 or the rank below it in the cases with primary lesions as T_3 level.