CAJ | 학술논문

目的研究新辅助化疗诱导ⅢA期非小细胞肺癌(NSCLC)组织病理学反应对患者预后的影响.方法40例患者完成2个周期新辅助化疗后,19例(47.5%)获客观缓解,其中完全缓解2例(5%),部分缓解17例(42.5%).40例ⅢA期NSCLC患者接受2个周期的新辅助化疗后手术,化疗方案由丝裂霉素、长春地辛和顺铂组成.手术后检查切除肿瘤标本的组织病理学反应.肿瘤组织对化疗的反应根据肿瘤坏死程度和残留肿瘤组织范围分为Ⅳ级、Ⅲ级、Ⅱ级和Ⅰ级.评价患者生存期与肿瘤组织对化疗反应等级之间的关系.结果40例患者的肿瘤切除标本中,2例(5%)属Ⅳ级,16例(40%)为Ⅲ级,18例(45%)为Ⅱ级,4例为Ⅰ级.肿瘤组织反应为Ⅲ～Ⅳ级患者的手术完全性切除率明显高于Ⅰ～Ⅱ级患者(P＜0.05),中位生存期亦显著长于Ⅰ～Ⅱ级患者(P＜0.05).肿瘤组织反应属Ⅲ～Ⅳ级患者的3年生存率与Ⅰ～Ⅱ级患者比较明显为长(P＜0.05).结论由新辅助化疗诱导的肿瘤组织反应程度是ⅢA期NSCLC患者获成功治疗的关键因素.化疗后肿瘤切除标本上,有明显肿瘤组织反应(Ⅲ～Ⅳ级反应)存在提示患者预后较好.
목적연구신보조화료유도ⅢA기비소세포폐암(NSCLC)조직병이학반응대환자예후적영향.방법40례환자완성2개주기신보조화료후,19례(47.5%)획객관완해,기중완전완해2례(5%),부분완해17례(42.5%).40례ⅢA기NSCLC환자접수2개주기적신보조화료후수술,화료방안유사렬매소、장춘지신화순박조성.수술후검사절제종류표본적조직병이학반응.종류조직대화료적반응근거종류배사정도화잔류종류조직범위분위Ⅳ급、Ⅲ급、Ⅱ급화Ⅰ급.평개환자생존기여종류조직대화료반응등급지간적관계.결과40례환자적종류절제표본중,2례(5%)속Ⅳ급,16례(40%)위Ⅲ급,18례(45%)위Ⅱ급,4례위Ⅰ급.종류조직반응위Ⅲ～Ⅳ급환자적수술완전성절제솔명현고우Ⅰ～Ⅱ급환자(P＜0.05),중위생존기역현저장우Ⅰ～Ⅱ급환자(P＜0.05).종류조직반응속Ⅲ～Ⅳ급환자적3년생존솔여Ⅰ～Ⅱ급환자비교명현위장(P＜0.05).결론유신보조화료유도적종류조직반응정도시ⅢA기NSCLC환자획성공치료적관건인소.화료후종류절제표본상,유명현종류조직반응(Ⅲ～Ⅳ급반응)존재제시환자예후교호.
Objective: To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer (NSCLC). Methods: Forty patients with stage ⅢA NSCLC underwent two cycles of neoadjuvant chemotherapy with mitomycin, vindosine, and cisplatin followed by surgery. Histopathologic response in resection of the tumor was examined after surgery. Tumor regression was classified as grade Ⅳ, grade Ⅲ, grade Ⅱ, and grade Ⅰ according to the extent of tumor necrosis and the extent of the vital tumor tissues. The tumor regression grading was correlated with the survival time of the patients. Results: After two cycles of chemotherapy, 19 (47.5%) of 40 patients had objective response (2 complete and 17 partial response). In 40 resected tumor specimens,2 (5%) were classified as regression grade Ⅳ, 16 (40%) as regression grade Ⅲ, 18 (45%) as regression grade Ⅱ, and 4 (10%) as regression grade Ⅰ. The rate of complete surgical resection was significantly higher in patients with tumor regression grade Ⅲ-Ⅳ (＜10% vital tumor tissue)(P＜0.05). The median survival time in patients classified as having tumor regression grade Ⅲ-Ⅳ was significantly longer than that in patients who had regression grade Ⅰ-Ⅱ (P＜0.05). The 3-year survival rate in patients with regression grade Ⅲ-Ⅳ was markedly higher than that in patients who had regression grade Ⅰ-Ⅱ (P＜0.05). Conclusion: The extent of tumor regression induced by neoadjuvant chemotherapy is a critical issue for successful therapeutic approach in patients with stage ⅢA NSCLC. In resected specimens of tumors after chemotherapy, the presence of marked tumor regression (regression grade Ⅲ-Ⅳ) is predictive for superior survival time.