CAJ | 학술논문

目的通过随机对照研究、比较非小细胞肺癌(NSCLC)患者放化疗(POCRT)和单纯化疗(POCT)的疗效.方法对术后140例病理分期为Ⅲa-pN2的NSCLC患者用随机信封法分为POCRT组和POCT组,每组70例.两组化疗方案均采用紫杉醇和顺铂,共化疗4个周期.在第1、21、43、64天给予紫杉醇175 mg/m2,顺铂60 mg/m2静脉滴注.POCRT组在化疗的第1天给予同期放疗,50.4 Gy/28次.结果 POCRT组5年总生存率为37.9％;POCT组5年总生存率为27.5％,POCRT组死亡风险比为0.69(95％ CI,0.457 ～1.044,x2=3.224,P＞0.05).POCRT组5年无复发生存率为30.3％;POCT组5年无复发生存率为18.8％,POCT组复发风险比为1.49(95％ CI,1.008 ～2.204,x2=4.193,P＜0.05).亚组分析显示POCRT组能明显提高pN2淋巴结≥2枚患者总生存率(x2=5.308,P＜0.05).POCRT组复发率(x2=5.308,P＜0.05)和远处转移率(x2=3.840,P＜0.05)均显著低于POCT组.POCRT组1例患者死于脓毒血症,POCRT组发生3,4级放射性食管炎高于POCT组(x2=8.010,P＜0.05),两组血液学毒性相似且可耐受.结论和POCT相比,POCRT能减少Ⅲa-pN2的非小细胞肺癌患者的局部复发率和远处转移率,提高无复发生存率,POCRT未能提高总生存率.
목적 통과수궤대조연구、비교비소세포폐암(NSCLC)환자방화료(POCRT)화단순화료(POCT)적료효.방법 대술후140례병리분기위Ⅲa-pN2적NSCLC환자용수궤신봉법분위POCRT조화POCT조,매조70례.량조화료방안균채용자삼순화순박,공화료4개주기.재제1、21、43、64천급여자삼순175 mg/m2,순박60 mg/m2정맥적주.POCRT조재화료적제1천급여동기방료,50.4 Gy/28차.결과 POCRT조5년총생존솔위37.9％;POCT조5년총생존솔위27.5％,POCRT조사망풍험비위0.69(95％ CI,0.457 ～1.044,x2=3.224,P＞0.05).POCRT조5년무복발생존솔위30.3％;POCT조5년무복발생존솔위18.8％,POCT조복발풍험비위1.49(95％ CI,1.008 ～2.204,x2=4.193,P＜0.05).아조분석현시POCRT조능명현제고pN2림파결≥2매환자총생존솔(x2=5.308,P＜0.05).POCRT조복발솔(x2=5.308,P＜0.05)화원처전이솔(x2=3.840,P＜0.05)균현저저우POCT조.POCRT조1례환자사우농독혈증,POCRT조발생3,4급방사성식관염고우POCT조(x2=8.010,P＜0.05),량조혈액학독성상사차가내수.결론 화POCT상비,POCRT능감소Ⅲa-pN2적비소세포폐암환자적국부복발솔화원처전이솔,제고무복발생존솔,POCRT미능제고총생존솔.
Objective To compare the efficacy of postoperative concurrent radiochemotherapy (POCRT) and postoperative chemotherapy (POCT) alone on Ⅲa-pN2 non-small cell lung cancer (NSCLC).Methods A total of 140 postoperative patients with Ⅲ a-pN2 NSCLC were randomly divided into 2 equal groups:POCRT and POCT groups.For chemotherapy paclitaxel at a dose of 175 mg/m2 and cisplatin a dose of 60 mg/m2 were injected intravenously at 1,22,43,and 64 d.Totally 4 cycles were adopted with an interval of 21 d.The patients in the POCRT group additionally received radiotherapy (50.4 Gy/28 times) at 1 d of treatment.Follow-up was conducted at least 5 years or until the death of the patients.Results The 5-year overall survival rate of the POCRT group was 37.9％,and the POCT group was 27.5％.The hazard ratio for death of the POCRT group was 0.69 (95％ CI:0.457-1.044,x2 =3.224,P ＞ 0.05).The 5-year relapse-free survival ra(lt)()the POCRT group was 30.3％,and the POCT group was 18.8％.The recurrence hazard ratio of the POCT group was 1.49 (95％ CI:1.008-2.204,x2 =4.193,P ＜ 0.05).Subgroup analysis revealed that POCRT significantly increased the overall survival rate of the patients with ≥2 pN2 lymph nodes (x2 =5.308,P ＜ 0.05).The POCRT group had a significantly lower relapse (x2 =5.308,P ＜ 0.05) and distant metastasis (x2 =3.840,P ＜ 0.05) rates as compared to that of the POCT group.One case died of pyemia and 9 cases who suffered from grades 3 or 4 radiation esophagitis.These 2 groups showed similar and tolerable hematologic toxicities.Conclusions Compared with POCT,POCRT significantly reduces the local relapse and distant metastasis rates,and increases the relapse-free survival rate of the patients with Ⅲa-pN2 NSCLC,however,it fails to raise the overall survival rate.