新辅助化疗治疗Ⅲ期非小细胞肺癌的临床评价

Clinical Evaluation of Neoadjuvant Chemotherapy in Patients with Stage Ⅲ_A Non-Small Lung Cancer

目的 评价新辅助化疗 (术前诱导化疗 )在治疗ⅢA 期非小细胞肺癌 (NSCLC)中的应用价值。方法 将 10 2例Ⅲ A 期NSCLC患者随机分为 2个组 :新辅助化疗组 5 1例 ,诱导化疗后行手术治疗 ,其中 3 0例术前接受支气管动脉灌注 (BAI)化疗 ,2 1例术前接受全身化疗。单一手术组 5 1例 ,确诊后直接行手术治疗。结果 新辅助化疗组总有效率 (CR +PR )为 49.0 % (2 5 / 5 1) ,化疗不良反应患者可耐受。新辅助化疗组手术切除率和完全性切除率为 92 .2 %和 5 4.9% ,明显高于单一手术组 (72 .5 %和 3 5 .3 % ,P<0 .0 5 )。新辅助化疗组患者 (3 4例 )平均中位生存期为 2 5个月 ,2年生存率为 5 5 .9% (19/ 3 4)。单一手术组患者 (3 2例 )平均中位生存期为 13个月 ,2年生存率为 2 8.1% (9/ 3 2 )。 2组比较有显著性差异 (P <0 .0 5 )。结论 对ⅢA 期NSCLC患者进行新辅助化疗可提高手术切除率 ,延长患者中位生存期 ,提高患者 2年生存率。

Objective To evaluate the value of clinical application of neoadjuvant chemotherapy for treatment of stage Ⅲ A non small cell lung cancer(NSCLC).Methods One hundred and two patients with stage Ⅲ A NSCLC were randomly allocated into neoadjuvant chemotherapy group and surgery alone group.In neoadjuvant chemotherapy group(51 patients),30 patients received bronchial artery infusion(BAI) chemotherapy,21 patients received systemic chemotherapy before surgery.Results The response rate(RR) of chemotherapy(BAI and Systemic chemotherapy) was 49.0%(25/51).Toxicity of chemotherapy were tolerable.Surgery resection rate was 92.2% and complete resection rate was 56.9% in neoadjuvant chemotherapy group,much higher than in surgery alone group(72.5% and 35.3% respectively, P <0.05).The mean median period of survival was 25 months in neoadjuvant chemotherapy group,as compared with 13 months in surgery alone group( P <0.05).The estimated 2 year survival rate was 55.9% for neoadjuvant chemotherapy patents,significantly higher than that(28.1%) for surgery alone patients( P <0.05).Conclusion Neoadjuvant chemotherapy can improve surgery resection rate and increase the median period of survival and 2 year survival rate in patients with stage Ⅲ A NSCLC.