CAJ | 학술논문

目的对24例同时多原发非小细胞肺癌(synchronous multiple primary non-small-cell lung cancer,SMP-NSCLC)病例行生存分析,评估其预后影响因素.方法回顾分析2000年11月至2013年7月中日友好医院依据Martini临床标准诊断的24例SMP-NSCLC患者临床资料,对年龄、性别、肿瘤位置、术式、pT分期、pN分期、术后辅助放化疗等情况行单因素及多因素分析.结果 24例SMP-NSCLC病例均通过手术切除获得各病灶明确病理诊断及淋巴结转移情况,其中单侧16例,双侧8例.围手术期发生并发症2例,无围手术期死亡病例.总体5年生存率43.1％,中位生存期47个月.单因素分析中,年龄、性别、肿瘤位于同侧或双侧不同组间预后差异无统计学意义,全肺切除或切除2个肺叶的患者预后较仅行单一肺叶切除、单一肺叶合并亚肺叶切除或多个亚肺叶切除患者差(P =0.023),多原发NSCLC均归为pT1期的患者预后显著优于包含pT1期以上NSCLC患者(P=0.000),存在pN1转移的患者预后较pN0患者差(P=0.006).多因素分析中,手术术式(P =0.010)、pN分期(P =0.012)、术后辅助治疗情况(P=0.018)是同时多原发NSCLC患者预后的独立危险因素.结论手术治疗同时多原发NSCLC效果满意,尽可能保留肺功能的手术术式、pN0、术后辅助治疗是预后良好的影响因素,pT分期可能通过影响pN分期进而影响多原发NSCLC治疗预后.
목적 대24례동시다원발비소세포폐암(synchronous multiple primary non-small-cell lung cancer,SMP-NSCLC)병례행생존분석,평고기예후영향인소.방법 회고분석2000년11월지2013년7월중일우호의원의거Martini림상표준진단적24례SMP-NSCLC환자림상자료,대년령、성별、종류위치、술식、pT분기、pN분기、술후보조방화료등정황행단인소급다인소분석.결과 24례SMP-NSCLC병례균통과수술절제획득각병조명학병리진단급림파결전이정황,기중단측16례,쌍측8례.위수술기발생병발증2례,무위수술기사망병례.총체5년생존솔43.1％,중위생존기47개월.단인소분석중,년령、성별、종류위우동측혹쌍측불동조간예후차이무통계학의의,전폐절제혹절제2개폐협적환자예후교부행단일폐협절제、단일폐협합병아폐협절제혹다개아폐협절제환자차(P =0.023),다원발NSCLC균귀위pT1기적환자예후현저우우포함pT1기이상NSCLC환자(P=0.000),존재pN1전이적환자예후교pN0환자차(P=0.006).다인소분석중,수술술식(P =0.010)、pN분기(P =0.012)、술후보조치료정황(P=0.018)시동시다원발NSCLC환자예후적독립위험인소.결론 수술치료동시다원발NSCLC효과만의,진가능보류폐공능적수술술식、pN0、술후보조치료시예후량호적영향인소,pT분기가능통과영향pN분기진이영향다원발NSCLC치료예후.
Objective The clinical/pathological staging and optimal therapeutic strategy for synchronous multiple primary non-small-cell lung cancer(SMP-NSCLC) remain unclear.In this study,the survival of SMP-NSCLC patients after surgical therapy and the factors affecting survival were analyzed.Methods 24 cases of SMP-NSCLC diagnosed according to Martini clinical criteria and underwent surgical therapies in China-Japan Friendship Hospital from November 2000 to July 2013 were analyzed retrospectively.Age,gender,position of tumors,surgical procedure,pT stage,pN stage and postoperative adjuvant therapy were analyzed as potential prognostic factors using univariate(log-rank test model) and multivariate analyses(Cox proportional hazards model).Results Pathological diagnosis for all of the 24 cases of SMP-NSCLC were confirmed postoperatively,unilateral in 16 and bilateral in 8 patients.The morbidity during hospital stay was 8.3％ (two patients),with no perioperative death.The overall 5-year survival rate was 43.1％,and the median survival time was 47 months.In the univariate analysis,advanced age (P =0.949),gender (P =0.089) and position of tumors (P =0.765) had no influence on survival.Pneumonectomy or multiple lobectomy was a poorer prognostic factor,compared with single lobectomy,lobectomy together with sublobar resection and multiple sublobar resection (P =0.023).Better survival was obtained from patients with both tumors classified as pT1 rather than at least one of the tumors classified as pT2 or even higher stage(P =0.000).N1 metastasis was also a poor prognostic factor(P =0.006).In the multivariate analysis,surgical procedure (P =0.010),pN stage (P =0.012) and postoperative adjuvant therapy(P =0.018) were identified as independent prognostic factors.Conclusion The survival of SMP-NSCLC patients after surgical therapy was satisfactory.Pulmonary function preservation may affect survival more rather than radical resection,also less pN stage and postoperative adjuvant therapy leaded to better survival.Worse survival obtained from higher pT stage might since pN stage updated.