CAJ | 학술논문

目的探讨非小细胞肺癌( NSCLC)手术5年后无复发患者晚期复发的风险和意义.方法以496例行完全性切除术的Ⅰ期、ⅡA期的非小细胞肺癌患者为研究对象,于术后前2年每3个月至门诊复查1次,2年后每6个月复查1次.包括查体、影像学检查和检查肿瘤标志物,必要时进行病理学检查.5年无复发者336例继续随访3年,并收集相关的临床、病理资料,主要观察终点是肺癌复发,数据收集至2011年1月.采用Kaplan-Meier法估算无复发生存率,Log-rank法进行生存率显著性检验,应用Cox比例风险回归模型进行多因素分析探讨晚期复发与危险因素之间的关系.结果 496例患者术后5年109例死于肺癌复发,33例死于其他原因,18例带瘤生存,336例无复发.无复发者继续随访3～36个月,中位27个月.随访期中34例(10.1％)发生晚期复发,局部复发(纵隔淋巴结复发6例、同侧肺复发3例、胸膜播散2例、其他2例)13例(38.2％),远处转移(多器官转移8例、单器官转移13例中对侧肺脏5例、肝脏3例、中枢神经2例、其他3例)21例(61.8％).单因素分析发现吸烟、癌胚抗原、分化程度、瘤内淋巴管浸润、瘤内血管浸润、胸膜受累和病理分期是影响3年无复发生存率的因素.多因素分析显示瘤内血管浸润和瘤内淋巴管浸润是影响晚期复发的独立危险因素.结论完全性切除术5年后的NSCLC患者仍存在晚期复发风险,尤其是有瘤内血管浸润和淋巴管浸润的患者,对于该类患者术后5年继续随访是有必要和有意义的.
목적 탐토비소세포폐암( NSCLC)수술5년후무복발환자만기복발적풍험화의의.방법 이496례행완전성절제술적Ⅰ기、ⅡA기적비소세포폐암환자위연구대상,우술후전2년매3개월지문진복사1차,2년후매6개월복사1차.포괄사체、영상학검사화검사종류표지물,필요시진행병이학검사.5년무복발자336례계속수방3년,병수집상관적림상、병리자료,주요관찰종점시폐암복발,수거수집지2011년1월.채용Kaplan-Meier법고산무복발생존솔,Log-rank법진행생존솔현저성검험,응용Cox비례풍험회귀모형진행다인소분석탐토만기복발여위험인소지간적관계.결과 496례환자술후5년109례사우폐암복발,33례사우기타원인,18례대류생존,336례무복발.무복발자계속수방3～36개월,중위27개월.수방기중34례(10.1％)발생만기복발,국부복발(종격림파결복발6례、동측폐복발3례、흉막파산2례、기타2례)13례(38.2％),원처전이(다기관전이8례、단기관전이13례중대측폐장5례、간장3례、중추신경2례、기타3례)21례(61.8％).단인소분석발현흡연、암배항원、분화정도、류내림파관침윤、류내혈관침윤、흉막수루화병리분기시영향3년무복발생존솔적인소.다인소분석현시류내혈관침윤화류내림파관침윤시영향만기복발적독립위험인소.결론 완전성절제술5년후적NSCLC환자잉존재만기복발풍험,우기시유류내혈관침윤화림파관침윤적환자,대우해류환자술후5년계속수방시유필요화유의의적.
Objective To investigate the risk fairs and significance of late recurrence in non-small cell lung cancer (NSCLC)patients who had undergone complete resection and remained recurrence-free for5 years.Methods 496 individuals diagnosed and surgically treated for Stage Ⅰ and Ⅱ A NSCLC were included.We examined patients at 3-month intervals for the first 2 years after surgery and typically at 6-month intervals thereafter on an outpatient basis.The follow-up evaluation included physical examination,inaging examination and tumor narkers.Pathological examination had also been performed when needed.Of these,336 patients remained recurrence-free for 5 years were followed up continuously for 3 years.Clinicopathologic factors were collected including age,sex,smoking history,preoperative serum carcinoembryonic antigen (CEA) level,surgical apprach,maximum tumor dimension on resected specimen,histologic type,histologic differentiation,intratumoral lymphatic permeation,intratumoral vascular invasion,pleural invasion and pathologic stage.The primary end event was lung cancer recurrence.The data collection ended in January 2011.Kaplan-Meier method was used for survival rate.Survival difference wasevaluated bylog-rank test.Multivariate Cox regression was used to test the relationship of recurrence-free probability to various clinicopathologic factors.Results At 5 years after resection,109 patients had died of disease and 33 had died of other causes.18 patients were alive with disease.The remaining 3 - 36 patients were alive and recurrence-free for the first 5 years.The median follow-up period of these 5-year recurrence free survivors was 27 months (range,3-36 months).34 (10.1％)patients developed a late recurrence at 3 years among the 336 patients.Recurrence was locoregional in 13 (38.2％)patients:6 patients in mediastinal lymph nodes,3 patients in ipsilateral lung,2 patients with pleural dissemination and 2 patients in other locations.Recurrence was distant in 21 (61.8％) patients:8 patients with multiple-organ metastases,13 patients with single-organ metastasis,and the latter consisted of 5 patients in contralateral lung,3 patients in liver,2 patients in central nervous system and 3 patients in other locations.Smoking history,preoperative serum CEA level,histologic differentiation,intratumoral lymphatic invasion,intratumoral vascular invasion,pleural invasion and pathologic stage were risk factors for late recurrence in univariate analysis.Multivariate Cox analysis demonstrated that intratumoral vascular invasion and intratumoral lymphatic invasion were independent risk factors for late recurrence.Conclusion NSCLC patients have a significant risk of late recurrence after complete resection 5 years,especially for the patients with intratumoral vascular invasion and intralumoral lymphatic invasion.It is needed and significant for the patients to follow up continuously after 5 years of complete resection.