CAJ | 학술논문

目的分析ⅢA-N2期非小细胞肺癌患者的临床情况和影响预后的相关因素,探讨手术及辅助治疗对预后的影响.方法回顾性分析2000年1月至2005年12月经手术治疗的657例ⅢA-N2期非小细胞肺癌患者的临床资料,应用Kaplan-Meier法进行生存分析.单因素分析各变量与预后的关系采用Log-rank检验,多因素分析采用Cox模型.结果术后全组患者的l、3和5年累计生存率分别为64.4%、26.0%和17.9%,中位生存期18个月.单因素分析中,影响生存期的不利因素为:肿瘤最大径>3 cm,高T分期,N2淋巴结无跳跃转移,纵隔淋巴结阳性数>4个,隆突下淋巴结阳性,治疗方式(单纯手术预后差,患者术后联合放化疗优于术后单纯化疗),术后未放疗、化疗,化疗周期小于4个.多因素分析显示,肿瘤直径(P=0.001),隆突下淋巴结阳性(P=0.019),纵隔淋巴结转移个数(P=0.006),术后化疗周期(P=0.007),术后放疗(P=0.055)和术后放化疗(P=0.026)对预后有明显影响.结论 ⅢA-N2期非小细胞肺癌患者5年生存率低,肿瘤直径、隆突下淋巴结阳性、纵隔淋巴结转移个数、术后化疗周期、术后联合放化疗是影响预后的独立因素.术后单站和多站纵隔淋巴结转移的预后相似,影响预后的主要是纵隔淋巴结的阳性个数,术后联合放化疗优于术后单纯化疗.
목적 분석ⅢA-N2기비소세포폐암환자적림상정황화영향예후적상관인소,탐토수술급보조치료대예후적영향.방법 회고성분석2000년1월지2005년12월경수술치료적657례ⅢA-N2기비소세포폐암환자적림상자료,응용Kaplan-Meier법진행생존분석.단인소분석각변량여예후적관계채용Log-rank검험,다인소분석채용Cox모형.결과 술후전조환자적l、3화5년루계생존솔분별위64.4%、26.0%화17.9%,중위생존기18개월.단인소분석중,영향생존기적불리인소위:종류최대경>3 cm,고T분기,N2림파결무도약전이,종격림파결양성수>4개,륭돌하림파결양성,치료방식(단순수술예후차,환자술후연합방화료우우술후단순화료),술후미방료、화료,화료주기소우4개.다인소분석현시,종류직경(P=0.001),륭돌하림파결양성(P=0.019),종격림파결전이개수(P=0.006),술후화료주기(P=0.007),술후방료(P=0.055)화술후방화료(P=0.026)대예후유명현영향.결론 ⅢA-N2기비소세포폐암환자5년생존솔저,종류직경、륭돌하림파결양성、종격림파결전이개수、술후화료주기、술후연합방화료시영향예후적독립인소.술후단참화다참종격림파결전이적예후상사,영향예후적주요시종격림파결적양성개수,술후연합방화료우우술후단순화료.
Objective To analyze the clinical conditions of postoperative patients with Ⅲ A-N2 non-small cell lung cancer (NSCLC) and the prognostic factors related with survival of NSCLC, and to investigate the influence of operation and therapy on prognosis. Methods Clinical data of 657 inpatient cases with Ⅲ A-N2 NSCLC admitted from January 2000 to December 2005 was retrospectively reviewed. The Kaplan-Meier method was used for survival analysis. The Log-rank law was applied to analyze the relationship between the variables and the prognosis in monovariate analysis, while Cox proportional hazard regression model was used to make multivariate analysis. Results The 1-, 3-and 5-year accumulative survival rates of the operative patience were 64.4%, 26.0% and 17.9%, respectively. The median survival time was 18 months. In monovariate analysis, the main unfavorable factors that affect life span involve were the diameter of tumor, T stage, skip metastasis of N2 lymph node, the number of metastatic lymph nodes, the metastasis of subcarinal lymph nodes, adjuvant chemotherapy, the cycle of adjuvant chemotherapy, postoperative radiotherapy, and the modality of therapy (the effect of naive surgery was disappointed, while the prognosis of the patients with adjuvant ehemoradiotherapy was better than those with chemotherapy alone). A multivariate analysis using Cox regression identified 5 factors of prognosis: the diameter of tumor (P = 0. 001 ), the metastasis of subcarinal lymph nodes ( P = 0. 019), the number of metastatic lymph nodes ( P = 0. 006), the cycle of adjuvant chemotherapy ( P = 0. 007 ), postoperative radiotherapy ( P = 0. 055 ), and adjuvant ehemoradiotherapy (P = 0. 026). Conclusions The 5-year survival rate of the patients with Ⅲ A-N2 Non-small cell lung cancer is poor. Tumor size, the metastasis of subcarinal lymph nodes, the number of metastatic LNs, the cycle of adjuvant chemotherapy, and postoperative radiotherapy have an effect on theprognosis. The prognosis of postoperative patients with single-level N2 and multi-level N2 disease is similar, and the key point of survival is the number of nodes involved. The therapeutic effect of patience given adjuvant chemoradiotherapy is superior to those treated with adjuvant chemotherapy.