术后放射治疗对非小细胞肺癌疗效的影响

Influence of Postoperative Radiotherapy on the Patients with Completely Resected Non-small Cell Lung Cancer

目的:探讨术后放射治疗对非小细胞肺癌疗效的影响。方法:1989年1月至1993年12月,在本院接受手术治疗的非小细胞肺癌患者中有189例无肉眼和镜下残留。病理分期为T1～3、N1～2、M0,其中75例接受术后放射治疗(综合组),114例单纯手术治疗(手术组)。综合组于术后22～53天开始照射患侧肺门和纵隔,剂量为46～66Gy/23～33次/5～7周(中位数56Gy)。用寿命表及Log-Rank法计算和比较两组病例的生存率与局控率。结果:两组病例的年龄、性别、病理类型、临床分期和手术方式等基本相同。综合组1、3、5年生存率分别为82.7%、40.0%、29.3%;手术组分别为76.3%、39.5%、28.1%,两组比较差异无显著意义(χ2=0.25,P=0.6233)。综合组1、3、5年局控率分别为95.7%、78.5%、68.5%,明显高于手术组的81.0%、58.3%、55.1%(χ2=4.4961,P=0.03691)。综合组出现胸内复发的中位时间为22.5个月(7～47个月),手术组为12.0个月(4～60个月),两组比较差异有显著意义(χ2=4.103,P=0.043)。结论:术后放射治疗能提高有肺门或纵隔淋巴结转移Ⅱ、Ⅲa期非小细胞肺癌的局控率,延长复发出现的时间,但未能改善其生存率。

Objective:A retrospective study was conducted to research the influence of postoperative radiotherapy on the patients with completely resected non-small cell lung cancer(NSCLC).Methods:From Jan.1989to Dec.1993,among the patients with NSCLC who underwent radical surgery in our center,there were189patients with completely resected,pathologically staged T 1-3 ?N 1-2 ?M 0 NSCLC.A total of75cases of these patients received postoperative radiother-apy with dose of46～66Gy in mediastinum and hilus(S+R group),except other114cases(S group).The survival rates and local control rates were analyzed and compared by the life table and Log-Rank test.Results:The clinical characteristics of patients such as age,sex,pathologic type,mode of operation were similar between two groups.The1,3,5-year survival rates were82.7%?40.0%?29.3%,respectively in S+R group and76.3%?39.5%?28.1%,respectively in S group,with no significant difference between two groups(χ 2 =0.25,P=0.6233).The1,3,5-year local control rates were95.7%?78.5%?68.5%,respectively in S+R group in contrast to81.0%?58.3%?55.1%respectively in S group(χ 2 =4.4961,P=0.03691).The median time of local recur-rence was22.5months in S+R group and12.0months in S group,with significant difference be-tween two groups(χ 2 =4.103,P=0.043).Conclusion:Postoperative radiotherapy can increase the lo-cal control rates and prolong the time of local recurrence for the patients with completely resect-ed,pathologically staged T 1-3 ?N 1-2 ?M 0 NSCLC,but the survival rates can not be improved.