Stage Ⅲ should be subclassified into Stage ⅢA and ⅢB in the American Joint Committee on Cancer(8^(th) Edition) staging system for pancreatic cancer

AIM To ascertain the prognostic role of the T4 and N2 category in stage Ⅲ pancreatic cancer according to the 8 th edition of the American Joint Committee on Cancer(AJCC) classification.METHODS Patients were collected from the Surveillance Epidemiology and End Results(SEER) database(2004-2013) and were divided into three groups: T(1-3)N2, T4 N(0-1), and T4 N2. Overall survival(OS) and disease-specific survival(DSS) of patients were evaluated by the Kaplan-Meier method. RESULTS For the first time, we found a significant difference in OS and DSS between T(1-3)N2/T4 N(0-1) and T4 N2 butnot between T(1-3)N2 and T4 N(0-1). A higher grading correlated with a worse prognosis in the T(1-3)N2 and T4 N2 groups.CONCLUSION Patients with stage T4 N2 had a worse prognosis than those with stage T(1-3)N2/T4 N(0-1) in the 8 th edition AJCC staging system for pancreatic cancer. We recommend that stage Ⅲ should be subclassified into stage ⅢA [T(1-3)N2/T4 N(0-1)] and stage ⅢB(T4 N2).

The famous Chinese medicine doctor Xue Jing-Dong Taohong Siwu Decoction cured 1 case of primary liver cancer stage Ⅲa

Primary liver cancer is the most common malignant tumor of the liver.Surgery,intervention,radiotherapy,and chemotherapy are the main treatment methods in the early stage,and the basic principles of post-treatment are palliative treatment and symptomatic treatment.Xue Jing-Dong,a famous Chinese doctor,started from the etiology and pathogenesis of liver cancer,used the methods of promoting blood circulation to remove blood stasis,nourishing blood and replenishing liver,and applied Taohong Siwu Decoction based on long-term clinical experience to cure 1 case of primary liver cancer stage Ⅲa in two years.The patient’s survival period can be prolonged and the quality of life can be improved.The author begins with the diagnosis of stage Ⅲa liver cancer,western medicine treatment methods,and previous treatment experience of traditional Chinese medicine,and briefly describes the diagnosis and treatment of this patient.

手术完全切除的Ⅲ_A(N_2)期非小细胞肺癌失败表型分析

背景与目的:Ⅲ_A(N_2)期非小细胞肺癌(non-small cell lung cancer,NSCLC)总体生存不佳,5年生存率为15%~30%。该研究旨在探讨Ⅲ_A(N_2)期NSCLC患者肿瘤完全切除术后患者的首次失败表型,明确各部位远处转移发生的风险,为术后治疗的选择提供临床依据。方法:对2005年1月—2012年7月收治的经手术完全切除的Ⅲ_A(N_2)期NSCLC患者进行回顾性分析。观察患者无进展生存期(progression-free survival,PFS)、总生存期(overall survival,OS)、首次失败表型以及首次失败表型的发生率和发生时间。生存分析和首次失败发生率采用Kaplan-Meier法计算。结果:入组患者共357例。全组患者的中位PFS为20.0个月,OS为43.1个月,5年总生存率为36.9%。病程中284例(77.6%)患者出现进展,首次失败表型:61例局部区域复发,197例远处转移,26例进展时既有局部区域复发又有远处转移。首次失败表型是远处转移中最主要的转移部位是脑、骨、肺,其中脑最常见,共67例患者。首次失败表型是局部区域复发的中位时间是13.6个月,而首次失败表型是远处转移的中位时间是15.1个月。首次失败表型是脑转移发生时间均较早,92.5%的患者均在3年内发生。结论:手术完全切除的Ⅲ_A(N_2)期NSCLC的首次失败表型中,远处转移显著高于局部区域复发;脑是远处转移作为首次失败表型最常见的部位。本研究为该类患者化疗时间的选择、术后放疗价值以及是否需要行全脑预防性放疗提供了一定的理论依据。

Ⅲ_A期非小细胞肺癌的术后放射治疗

放射治疗在Ⅲ_A期非小细胞肺癌(NSCLC)地位一直颇受争议,但随着放射治疗技术发展以及研究的不断深入,Ⅲ_A期非小细胞肺癌术后放疗的价值逐渐得到大家的认同。本文对Ⅲ_A期非小细胞肺癌术后放射治疗价值、放疗技术的应用、靶区设计及影响放疗疗效的因素等方面进行概述。

Prognostic and predictive significance of MSI in stages Ⅱ/Ⅲ colon cancer

In colon cancer,classic disease staging remains the key prognosis and treatment determinant.Although adjuvant chemotherapy has an established role in stageⅢcolon cancer patients,in stageⅡit is still a subject of controversy due to its restriction to a small subgroup of patients with high-risk histopathologic features.Patients with stageⅡtumors form a highly heterogeneous group,with five-year relative overall survival rates ranging from 87.5%(ⅡA)to 58.4%(ⅡC).Identifying those for whom adjuvant chemotherapy would be appropriate and necessary has been challenging,and prognostic markers which could serve in the selection of patients more likely to recur or benefit from adjuvant chemotherapy are eagerly needed.The stronger candidate in this category seems to be microsatellite instability(MSI).The recently reported European Society for Medical Oncology guidelines suggest that MSI should be evaluated in stageⅡcolorectal cancer patients in order to contribute in treatment decisionmaking regarding chemotherapy administration.Thehypothetical predictive role of MSI regarding its response to 5-fluorouracil-based adjuvant chemotherapy has proven a much more difficult issue to address.Almost every possible relation between MSI and chemotherapy outcome has been described in the adjuvant colon cancer setting in the international literature,and the matter is far from being settled.In this current report we critically evaluate the prognostic and predictive impact of MSI status in patients with stageⅡand stageⅢcolon cancer patients.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Effect of TCM Combined with Chemotherapy on Immune Function and Quality of Life of Patients with Non-small Cell Lung Cancer inStage Ⅲ-Ⅳ

Objective: To observe and compare the effect of traditional Chinese medicine (TCM) combined with chemotherapy (CT) on immune function and quality of life (QOL)of patients with non-small cell lung cancer (NSCLC) in stage Ⅲ-Ⅳ. Methods: One hundred cases with stage Ⅲ-Ⅳ NSCLC were randomly divided into two groups. The treated group (n=50) received CT combined with TCM, and the control group received CT alone. The percentage of T lymphocyte subset in peripheral blood and the change of natural killer (NK) cell count were observed after treatment. The QOL and tolerance of CT were also compared between the two groups after treatment. Results: In the treated group, CD3 cell count, CD4 cell count, CD4/ CDg ratio and NK cell activity were higher than those in control group, while CD8 cell count in the treated group was lower than that in the control group (P<0.05), and QOL and tolerance of CT in the treated group were also better (P<0.05). Conclusion: TCM combined with CT could raise the patients' ability in tolerating CT in stage Ⅲ-ⅣNSCLC.

Role of radiation therapy in the management of stage Ⅲ non-small cell lung cancers: current status and controversies

The treatment of stage Ⅲ non-small cell lung cancer(NSCLC) consisting of the heterogeneous stage subsets remains a challenge. Overall, it has been gradually recognized that radiation therapy(RT) plays a crucial role in the management of stage Ⅲ NSCLC. One superior sulcus tumors are the subset for which the trimodality treatments are clearly preferred. One subset of stage Ⅲ NSCLC has a minimal disease burden with microscopic p N2 disease or with discrete p N2 involvement identified preoperatively, thus technically could undergo a surgical resection. For the incidentally found p N2 disease after complete surgery(ⅢA-1, ⅢA-2), the value of postoperative radiotherapy(PORT) has been recognized by a reassessment based on new data. However, doubt persists regarding how to define the clinical target volume for PORT. For the discrete p N2 involvement identified preoperatively(a selected part of ⅢA-3), induction chemoradiation therapy(CRT) before surgery may yield a survival advantage, although the phase Ⅲ randomized trials in this issue are not conclusive. The other major subset of stage Ⅲ NSCLC is the infiltrative stage Ⅲ NSCLC with N2 or N3 nodal disease(ⅢA-3, ⅢA-4, and ⅢB), for which concurrent CRT is considered as the current standard of care. The potential role of radiation dose escalation/acceleration has been proposed; however, the optimal dose fractionation remains an important unresolved question. Additionally, the role of prophylactic cranial irradiation for stage Ⅲ patients with high risk of brain metastasis is worth of further assessment. Moreover, how to integrate molecular targeted therapy with RT, as well as whether they had a role in stage Ⅲ diseases, are other controversies actively under study in ongoing trials. This review specifically describes the updated role of RT in multimodal approach to treat stage Ⅲ NSCLC and the controversies regarding these results in various situations.

Yiqi Huoxue Decoction in the treatment of Qi and yin deficiency and stasis type diabetic nephropathy in stageⅢ and its effect on VEGF and TGF-β1

Objective:To observe the efficacy of Yiqi Huoxue Decoction in the treatment of patients with diabetic nephropathy(DN)stageⅢwith qi and yin deficiency and stasis and its effects on vascular endothelial growth factor(VEGF)and transforming growth factor-β(TGF-β1).Methods:Sixty patients with stage DN of Qi-yin deficiency and stasis type DN who were treated in the Endocrinology Department of the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from September 2018 to December 2019 were selected as the research subjects.The remainder method was used to divide them into 30 cases in the observation group and 30 cases in the control group.Patients in both groups were referred to the guidelines and expert consensus for general treatment of DN(hypogl-ycemic,antihypertensive,lipid-lowering,etc.).The control group was given pancreatic kallikrein enteric-coated tablets orally once,120U,3 times a day,and the observation group was given The traditional Chinese medicine Yiqi Huoxue Decoction was taken orally,one dose daily,twice a day in the morning and evening;the two groups intervened continuously for 8 weeks.Detect blood FPG,PBG,HbA1c,β2-MG,BUN,SCr,VEGF,TGF-β1,and urine mALB and UACR levels before and after treatment,and calculate eGFR before and after treatment in both groups;observe changes in TCM syndrome scores in the two groups,Compare its clinical efficacy.Results:After 8 weeks of treatment,the total clinical effective rate of patients in the observation group was 93.3%,which was significantly different from the control group of 76.6%(P<0.05);the TCM syndrome scores in the observation group were significantly lower than those before treatment and in the control group(P<0.05);The levels of FPG,HbA1c,PPG,mALB,β2-MG,UACR,VEGF,and TGF-β1 in the observation group were significantly lower than those in the control group,with significant differences(P<0.05).The levels of SCr and BUN in the observation group were significantly lower.Compared with before treatment,eGFR increased,but there was no signi-ficant difference(P>0.05).Conclusion:Yiqi Huoxue Decoction for the treatment of patients with DN typeⅢqi-yin deficiency and stasis type,not only helps to lower blood sugar levels,improve TCM syndromes,but also can reduce early renal damage,reduce urine albumin,and delay kidney function It may be further worsened and has better safety.The mechanism may be related to reducing the levels of VEGF and TGF-β1,thereby delaying the fibrosis of tubulointerstitial scar and inhibi-ting glomerular capillary sclerosis.

Bushen Huoxue method combined with ACEI/ARB in treating diabetic kidney disease (stage Ⅲ):A meta-analysis and trial sequential analysis

Objective:To evaluate the efficiency of Bushen Huoxue method with ACEI/ARB in treating diabetic kidney disease(stageⅢ).Methods:A total of 8 major electronic databases(CNKI,WanFang,VIP,Sinomed,Pubmed,Embase,Cochrane Liberary,Web of Science)were retrieved since the establishment of the database to October 9,2019.Two reviewers extracted data,and assessed the methodological quality of the included studies.The analysis was made by Stata 15.0 and TSA 0.9 softwares.Results:A total of 10 RCT studies were obtained,including 711 patients with diabetic kidney disease of stageⅢ.Meta-analysis showed that the method of Bushen Huoxue with ACEI/ARB could reduce UAER[WMD=-31.24,95%CI(-42.98,-19.51)],β2-GM[WMD=-92.95,95%CI(-166.05,-19.85)],LDL-C[WMD=-0.19,95%CI(0.19,-0.30)].However,there were no significant effect for HbAlc[WMD=-0.08,95%CI(-0.17,-0.00)],Scr[WMD=-12.96,95%CI(-39.82,13.90)],BUN[WMD=-0.14,95%CI(-0.44,0.17)].The result of TSA indicated that the method of Bushen Huoxue with ACEI/ARB was effective in the treatment of diabetic kidney disease of stageⅢ.Conclusion:The study show that the method of Bushen Huoxue with ACEI/ARB can reduce urinary protein,renal tubular injury and LDL-C in patients with diabetic kidney disease of stageⅢ,and had no effect on HbAlc and renal function.But the conclusion of this study needs further research of high quality.

Unresectable stage Ⅲ non-small-cell lung cancer: Have we made any progress?

Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.

Ⅲa期非小细胞肺癌切除术的疗效分析

目的：总结Ⅲa期非小细胞肺癌切除术的治疗结果，探讨其临床特点及影响生存的因素。方法：采用STATA5．0软件建立病例资料数据库并进行统计分析。结果：本组术后并发症发生率为14．49％。术后30天内死亡率1．41％。5年生存率：根治术27．26％、姑息术14．20％（P＜005）；鳞癌3且．69％、腺癌10．26％（P＜0．001）。出现复发后积极治疗的1年生存率为38．89％，而不治疗无1年生存者（P＜0．05）。出现血行转移后积极治疗的2年生存率为16．75％，不治疗为4．99％（P＜0．05）。结论：手术性质、病理类型及出现复发转移后积极的治疗显著地影响预后。切缘无癌残留、综合治疗分别较切缘有癌残留、单一手术生存率高，但其差异无统计学意义。

Ⅲa(N_2)期非小细胞肺癌术后放疗疗效分析

目的:回顾性分析Ⅲa(N2)期非小细胞肺癌术后放疗的治疗结果,同时探讨其治疗策略。方法:1987～2004年本院收治的Ⅲa(N2)期非小细胞肺癌92例,所有病人都接受根治性手术,术后放疗46例(S+R组),单纯手术46例(S组),39例接受化疗;放疗中位剂量56 Gy(40～64 Gy)。用Kaplan-Meier及Log-rank法计算和比较两组病人的生存率。结果:(1)全组病人5年及10年总生存率(Overall survival,OS)分别为44.5%和30.4%。(2)术后放疗组与单纯手术组相比,5年及10年总生存率分别为49.1%、36.5%,36.3%、25.4%;两组间差异无统计学意义(χ2=0.83,P=0.65)。(3)纵隔单站转移N2病人,术后放疗组有提高无病生存率(Diseaes-free survival,DFS)的趋势;而多站转移N2病人,术后放疗组与单纯手术组相比,5年及10年无病生存率明显提高,分别为:40.6%、4.5%,21.2%、4.1%,差异有显著性(χ2=4.35,P=0.03),且有提高总生存率的趋势。(4)1996～2004年术后放疗病人的生存率优于1987～1995年。(χ2=4.28,P=0.04)。(5)治疗失败率63.0%,术后放疗组总复发率及局部区域复发率低于单纯手术组,差异具显著性,分别为50.0%、76.1%,(χ2=6.72,P=0.001);及8.7%、32.6%,(χ2=8.03,P=0.001)。两组失败的首位原因均为远处转移。(6)多变量分析结果显示,年龄和纵隔淋巴结受累的站数影响Ⅲa(N2)期非小细胞肺癌的生存。结论:(1)Ⅲa(N2)期非小细胞肺癌术后放疗有延长生存期的趋势,纵隔多站转移N2病人术后放疗可提高无病生存期。纵隔单站转移N2病人术后放疗价值不确切,有待于进一步的随机临床研究加以证实。(2)年龄和纵隔淋巴结受累的站数影响病人的生存期。(3)治疗设备和治疗技术可以影响术后放疗的价值。(4)无论是否放疗,失败的首位原因均为远处转移,提示这类病人可能从化疗获益,建议Ⅲa(N2)期非小细胞肺癌术后常规辅以化疗。

ⅢA期非小细胞肺癌患者新辅助化疗后胸腔镜肺叶切除效果

目的探讨ⅢA期非小细胞肺癌(NSCLC)患者新辅助化疗后胸腔镜肺叶切除治疗的疗效。方法收集30例ⅢA期NSCLC患者术前进行新辅助化疗为观察组,同期直接手术的ⅢA期NSCLC患者25例作为对照组。观察组患者术前采用紫杉醇脂质体+奈达铂方案化疗2个周期,对照组术前未进行化疗,术后行辅助化疗。观察两组手术切除率、术后并发症及预后情况。结果1观察组手术切除率为93.3%,对照组手术切除率为80.0%,两组比较差异有统计学意义(P<0.05)。2观察组并发症发生率为23.3%,对照组发生率为28.0%,两组比较差异无统计学意义(P>0.05)。3观察组1年生存率为86.7%,对照组为68.0%;观察组3年生存率为63.3%,对照组为52.0%;两组1、3年生存率比较差异有统计学意义(P<0.05)。结论新辅助化疗能有效提升NSCLC手术切除率,有效延长患者生存期,并且化疗不良反应均在可控范围之内。因此,ⅢA期的NACLC患者术前新辅助化疗加手术方案值得临床推广。

淋巴结降期对ⅢA～N_2期非小细胞肺癌患者术后远期疗效的影响

目的:观察ⅢA^N_2期非小细胞肺癌(NSCLC)诱导化疗加手术患者的术后复发及生存情况,分析淋巴结降期对预后的影响,探索术后放疗的必要性。方法:回顾性选取天津医科大学肿瘤医院2009年1月至2014年6月116例接受诱导化疗加手术的ⅢA^N_2期NSCLC患者116例,全组均为R0切除。Kaplan-Meier法计算局部无复发生存期(local-recurrence free survival,LRFS)、无远处转移生存期(distant-metastasis free survival,DMFS)和生存期(overall survival,OS),Log-rank法比较组间差异,Cox模型多因素预后分析。结果:全组中位随访时间24.42个月。pN_0、pN_1、pN_2期患者分别为40例(34.5%)、16例(13.8%)和60例(51.7%),3年复发率分别为27.5%、56.2%和51.7%。77例患者接受了辅助化疗,其中pN_0、pN_1、pN_2患者3年复发率分别为26.9%、58.3%和46.2%。多因素分析中,pN_0是影响LRFS的因素。pN_1组的LRFS短于pN_0组(P=0.048),pN_1组和pN_2组的LRFS差异无统计学意义(P=0.314)。全组5年生存率为46.6%,多因素分析显示pT_1、pN_(0~1)、诱导化疗疗效是影响OS的因素。pN_2组的OS短于pN_1组和pN_0组(P<0.05),pN_1组和pN_0组的OS差异无统计学意义(P=0.412)。结论:淋巴结降期虽然是ⅢA^N_2期NSCLC诱导化疗加手术患者的良好预后因素,但是淋巴结降期的pN_0和pN_1患者,即使接受了辅助化疗,仍有较高复发风险,有必要探索诱导化疗+手术+术后放疗的新模式。

pN_2～ⅢA期非小细胞肺癌患者的术后生存状况和预后因素分析

目的探讨p N_2～ⅢA期非小细胞肺癌(NSCLC)患者术后的远期生存情况及其影响因素。方法收集2010年10月至2013年6月于北京胸科医院就诊的119例p N_2～ⅢA期NSCLC患者的临床及随访资料。采用单因素Kaplan-Meier法和多因素Cox回归模型分析119例接受根治手术患者的总生存期(OS)、无进展生存期(PFS)、肺内PFS及其影响因素。结果119例患者的1、3、5年生存率分别为88.2%、53.8%和35.7%,中位OS为43个月(95%CI:31.49～54.51个月)。单因素分析显示N_2分类(N_(2al)、N_(2a2)、N_(2b))、术后辅助化疗、术后辅助放疗均为影响预后的因素,Cox多因素分析显示N_2分类和术后辅助放疗为影响OS的独立危险因素,N_(2a2)、N_(2b)及术后未辅助放疗患者较N_(2a1)、术后辅助放疗患者的OS缩短,死亡风险倍数分别为2.279、2.841、1.959倍(P<0.05);而N_2分类、术后辅助化疗及术后辅助放疗均为影响PFS、肺内PFS的独立危险因素。对N_2转移患者进行单站转移N_2和多站转移N_2分组,结果显示单站转移N_2患者中术后是否辅助放疗在OS、PFS、肺内PFS的差异均无统计学意义(P>0.05),多站转移N_2患者中术后是否辅助放疗在OS、PFS、肺内PFS的差异均有统计学意义(P<0.05)。结论N_2分类为影响p N_2～ⅢA期NSCLC患者的重要预后因素,术后辅助放化疗能提高局部控制和远期生存,其中术后辅助放疗使多站转移N_2患者明显获益。

新辅助化疗在Ⅲa期非小细胞肺癌治疗中的应用

目的探讨新辅助化疗对Ⅲa期非小细胞肺癌(non-smallcelllungcancer,NSCLC)手术切除率和术后生存率的影响。方法1999年1月至2005年1月收治的293例ⅢaNSCLC患者随机分为新辅助化疗组(136例)及单纯手术组(157例),对两组病人的临床资料进行统计学分析。结果新辅助化疗近期疗效总有效率53.1%;外科手术切除率较单纯手术组高,差异显著(P<0.05);术后1、3年生存率均较单纯手术组高,差异显著(P<0.05)。结论进行新辅助化疗可显著提高Ⅲa期肺癌患者手术切除率,延长患者生存期。

新辅助化疗在Ⅲa期肺癌治疗中的应用

目的探讨新辅助化疗对Ⅲa期非小细胞肺癌患者手术切除率和术后生存率的影响。方法对183例Ⅲa期肺癌患者(新辅助化疗组)及同期收治的192例Ⅲa期肺癌患者(单纯手术组)的临床资料进行分析。结果新辅助化疗近期总有效率53.5%;手术切除率较单纯手术组高(P<0.05);术后1、3年生存率均较单纯手术组高。结论进行新辅助化疗可显著提高Ⅲa期肺癌患者手术切除率,延长患者生存期。

ⅢA-N2期非小细胞肺癌术前新辅助放化疗临床分析

目的：探讨新辅助放化疗联合手术治疗ⅢA-N2期非小细胞肺癌的疗效及预后。方法：选取2008年11月-2015年3月濮阳市油田总医院收治的128例ⅢA-N2期非小细胞肺癌患者,随机划分为实验组（64例）和对照组（64例）,均行术前3个周期的紫杉醇＋顺铂方案化疗,每3周为1个周期;实验组：3周期化疗后行三维适形放疗,对照组仅行术前化疗;术后所有患者均再行原方案化疗3周期。对比分析经两组患者术前新辅助放化疗的疗效、不良反应及预后因素。结果：实验组放化疗后有效率为79.7%,疾病控制率为96.9%。中位无进展生存时间11.8个月,中位生存期26.3个月,1年生存率为93.8%;对照组化疗后有效率为59.4%,疾病控制率为85.9%。中位无进展生存时间8.2个月,中位生存期19.8个月,1年生存率为81.3%。两组间有效率、疾病控制率及生存率差异均有统计学意义（P〈0.05）,不良反应无明显统计学意义（P〉0.05）,对症支持治疗后均可恢复。结论：术前新辅助放化疗有利于提高预后,并且不增加患者不良反应。安全性好。可作为ⅢA-N2期非小细胞肺癌最佳治疗方案之一。

pN2-ⅢA期非小细胞肺癌患者的术后生存状况和预后因素分析

目的探讨pN2-III A期非小细胞肺癌(NSCLC)患者术后的远期生存情况及其影响因素.方法收集2010年10月至2013年6月于北京胸科医院就诊的119例pN2-ⅢA期NSCLC患者的临床及随访资料.采用单因素Kaplan-Meier法和多因素Cox回归模型分析119例接受根治手术患者的总生存期(OS)、无进展生存期(PFS)、肺内PFS及其影响因素.结果119例患者的1、3、5年生存率分别为88.2%.53.8%和35. 7%,中位OS为43个月(95%CI: 31.49?54. 51个月).单因素分析显示N2分类(N2al、N2a2、N2b)、术后辅助化疗、术后辅助放疗均为影响预后的因素,Cox多因素分析显示N2分类和术后辅助放疗为影响OS的独立危险因素,N2a2、N2b及术后未辅助放疗患者较N2al、术后辅助放疗患者的OS缩短,死亡风险倍数分别为2.279、2.841、1.959倍(P<0.05);而N2分类、术后辅助化疗及术后辅助放疗均为影响PFS、肺内PFS的独立危险因素.对N2转移患者进行单站转移N2和多站转移N2分组,结果显示单站转移M患者中术后是否辅助放疗在OS、PFS、肺内PFS的差异均无统计学意义(P >0.05 ),多站转移M患者中术后是否辅助放疗在OS、PFS、肺内PFS的差异均有统计学意义(P<0.05)。结论N2分类为影响pN2 ~ⅢA期NSCLC患者的重要预后因素,术后辅助放化疗能提高局部控制和远期生存,其中术肩辅助放疗使多站转移N2患者明显获益.