CAJ | 학술논문

目的探讨不同淋巴结切除方式在病理诊断为T1的cⅠA期非小细胞肺癌治疗中的作用.方法根据淋巴结切除方式的不同,将1998年1月至2002年5月115例病理诊断为T1的cⅠA期非小细胞肺癌患者分为系统性纵隔淋巴结清扫组(清扫组)和纵隔淋巴结采样组(采样组),回顾性分析两组的并发症、N分期及预后之间的差异,评价各临床病理因素与预后的关系.结果清扫组平均每例切除淋巴结(15.98±3.05)个,采样组平均每例切除淋巴结6.48±2.16个,两组差异有统计学意义(P＜0.01),但清扫组的手术时间、术后胸腔引流量及并发症发生率均多于采样组.两组在淋巴结分期的改变、总生存率与无病生存率等方面差异无统计学意义;进一步分析发现,当肿瘤直径＞2 cm时,清扫组与采样组的5年总生存率分别为78.2%和54.5%,无病生存率分别为75.1%和51.3%,清扫组均高于采样组(P＜0.05);当肿瘤直径≤2 cm时,两组的5年总生存率与无病生存率无明显差别.病理类型方面,大细胞癌和腺鳞癌5年总生存率低于腺癌和鳞状细胞癌(P＜0.05),有淋巴结转移的5年总生存率与无病生存率明显低于无淋巴结转移者(P均＜0.01).结论对于术中确定为T1的cⅠA期非小细胞肺癌,当肿瘤直径≤2 cm时,选择纵隔淋巴结采样术可以相对减小创伤;当肿瘤直径＞2 cm时,选择系统性纵隔淋巴结清扫术可能更有助于长期生存.
목적 탐토불동림파결절제방식재병리진단위T1적cⅠA기비소세포폐암치료중적작용.방법 근거림파결절제방식적불동,장1998년1월지2002년5월115례병리진단위T1적cⅠA기비소세포폐암환자분위계통성종격림파결청소조(청소조)화종격림파결채양조(채양조),회고성분석량조적병발증、N분기급예후지간적차이,평개각림상병리인소여예후적관계.결과 청소조평균매례절제림파결(15.98±3.05)개,채양조평균매례절제림파결6.48±2.16개,량조차이유통계학의의(P＜0.01),단청소조적수술시간、술후흉강인류량급병발증발생솔균다우채양조.량조재림파결분기적개변、총생존솔여무병생존솔등방면차이무통계학의의;진일보분석발현,당종류직경＞2 cm시,청소조여채양조적5년총생존솔분별위78.2%화54.5%,무병생존솔분별위75.1%화51.3%,청소조균고우채양조(P＜0.05);당종류직경≤2 cm시,량조적5년총생존솔여무병생존솔무명현차별.병리류형방면,대세포암화선린암5년총생존솔저우선암화린상세포암(P＜0.05),유림파결전이적5년총생존솔여무병생존솔명현저우무림파결전이자(P균＜0.01).결론 대우술중학정위T1적cⅠA기비소세포폐암,당종류직경≤2 cm시,선택종격림파결채양술가이상대감소창상;당종류직경＞2 cm시,선택계통성종격림파결청소술가능경유조우장기생존.
Objective To study the role of different lymphadenectomy in the treatment of selected clinical-stage ⅠA non-small cell lung cancer. Methods All 115 postoperative patients admitted from January 1998 to May 2002 with pathologic-stage T1 who had been preoperatively diagnosed as clinical-stage ⅠA non-small cell lung cancer were divided into a radical systematic mediastinal lymphadenectomy (LA) group and a mediastinal lymph node sampling (LS) group, impacts on morbidity, N staging, overall survival (OS) and disease-free survival (DFS) were evaluated in each group respectively. Associations between clinical-pathological parameters (age, sex, tumor location, tumor size, pathological type and lymph node metastases) and OS, DFS were analyzed. The cumulative OS and DFS was calculated by the Kaplan-Meier method and compared by the log-rank test. Results The mean number of dissected lymph nodes was (15.98±3.05) in LA group and (6.48±2.16) in LS group with a significant difference (P＜0.01). No statistically significant difference existed in modification of N staging, OS and DFS between LA group and LS group. However, for patients with lesions of a diameter more than 2 cm, 5-year OS in LA group was significantly higer than that in LS groups (LA vs. LS=78.2% vs. 54.5%, P＜0.05), also 5-year DFS was significantly higer (LA vs. LS=75.1% vs. 51.3%, P＜0.05). For patients with lesions of 2 cm or less, 5-year OS and 5-year DFS were similar in both groups. The early surgery-related parameters (duration of surgery, drain secretion and morbidity) indicated a slighter invasion in LS group. In addition, patients with large cell carcinoma and adenosquamous carcinoma were associated with significantly poor 5-year OS (P＜0.05), and patients with lymph node metastases were associated with poor 5-year OS as well as 5-year DFS(P＜0.01). Conclusions After being intraoperatively identified as T1 stage, patients with lesions of more than 2 cm in clinical-stage ⅠA non-small cell lung cancer should be performed with LA to get a better survival, and patients with lesions of 2 cm or less should be performed with LS to decrease invasion.