肺癌外科治疗210例的远期结果分析

Long-term outcome of lung cancer patients treated with surgical resection: A report of 210 cases

目的 探讨影响肺癌切除术后患者远期疗效的因素。方法 对 1987年 1月～ 1999年 12月间2 10例接受肺癌切除术患者的临床、病理和随访资料进行回顾性研究。选择 9个可能对预后产生影响的因素 ,通过COX比例风险模型进行多因素生存分析。结果 全组患者 3年生存率为 3 7.4% ,5年生存率为 3 0 .1% ,10年生存率为 2 3 .5 %。单因素分析显示 :p TNM分期中T和N的不同分期、肺癌组织学类型、手术方式和手术性质对手术后远期生存率的影响有统计学意义。多因素分析显示 :p TNM分期中T和N的不同分期和手术性质是影响预后的独立因素 ;N2 3 期肺癌患者手术后死亡的危险比 (hazardratio)是N0 1者的 2 .42倍 (P =0 .0 0 0 1) ,T2 4期肺癌患者术后死亡危险比是T1者的 3 .5 0倍 (P =0 .0 3 3 0 ) ,接受姑息性手术的患者术后死亡危险比是根治性切除者的 1.77倍 (P =0 .0 2 2 4)。结论 p TNM分期中T和N的不同分期和手术性质是影响预后的最重要的三个因素 ,要提高肺癌患者术后远期生存率 ,早期手术治疗是关键 ,同时手术中必须彻底清扫淋巴结 ,避免非根治性手术。

Objective To study the prognostic factors in patients with lung cancer after curative resection. Methods A retrospective study was conducted on 210 cases of clinicopathological survival data of lung cancer patients who underwent surgical resection from January 1987 to December 1999. Nine conventional prognostic factors were analyzed by COX model. Results The overall 3 , 5 and 10 year survival rates were 37.4%, 30.1% and 23.5% respectively. Univariate analysis showed that regional lymph nodes status (N), primary tumor status (T), histological type of lung cancer, the type of operation and curability of surgical resection were significantly related to disease specific survival. Multivariate analysis showed that regional lymph nodes status, primary tumor status and curability of surgical resection were the three independent predictors of long term outcome. The hazard ratio of death was 2.42 for patients with N2 3 vs N0 1( P =0.000 1), 3.50 for patients with T2 4 vs T1( P =0.033 0) and 1.77 for patients with incomplete resection vs complete resection ( P =0.022 4). Conclusion Primary tumor status, regional lymph nodes status and curability of surgical resection are the three important prognostic factors of lung cancer. In order to improve long term survival of lung cancer patients, it is very important to operate in the earlier stage of tumor, to extensively dissect intra pulmonary and ipsilateral mediastinal lymph nodes and to avoid incomplete resection.