中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
3期
367-371
,共5页
强光亮%梁朝阳%余其多%肖飞%温焕舜%冯宏响%张真榕%马千里%石彬%郭永庆%刘德若
彊光亮%樑朝暘%餘其多%肖飛%溫煥舜%馮宏響%張真榕%馬韆裏%石彬%郭永慶%劉德若
강광량%량조양%여기다%초비%온환순%풍굉향%장진용%마천리%석빈%곽영경%류덕약
癌,非小细胞肺%预后%纵隔%淋巴结转移%影响因素
癌,非小細胞肺%預後%縱隔%淋巴結轉移%影響因素
암,비소세포폐%예후%종격%림파결전이%영향인소
Carcinoma,non-small cell lung%Prognosis%Mediastinum%Lymphatic metastasis%Factor analysis
目的：探讨影响根治性手术治疗的ⅢA-N 2期非小细胞肺癌（NSCLC）患者预后的因素，并分析不同亚组的生存率差异。方法回顾中日友好医院2001年1月至2013年12月期间行肺癌根治术，并经病理证实为ⅢA-N 2期的92例NSCLC患者的临床病理资料。分析可能影响预后的因素，并用Kaplan-Meier曲线及Log-rank检验分析生存率差异，用Cox比例风险回归模型分析各因素对生存率的影响。结果单因素分析显示，组织学类型（P=0.001）、术后治疗（P=0.011）、纵隔淋巴结转移数量＞3（P=0.010）、纵隔淋巴结跨区域转移（P=0.010）、纵隔淋巴结多区域转移（P=0.013）是影响生存率的因素；多因素分析显示纵隔淋巴结转移数量＞3（P=0.007）和跨区域转移（P=0.046）是影响预后的独立危险因素。原发肿瘤在左肺下叶、右肺下叶者最易出现跨区域转移，发生率分别为53.3%和48.0%；其次是左肺上叶（31.6%）、右肺中叶（14.3%）和右肺上叶（11.5%）。结论纵隔淋巴跨区域转移和纵隔淋巴结转移数量＞3是独立的生存预后因素，作为ⅢA-N2期NSCLC的一种亚组特征，提示肿瘤侵袭性更高和预后不良。任何部位的肺癌均可发生纵隔淋巴结跨区域转移，下叶肺癌的跨区域转移发生率最高。
目的：探討影響根治性手術治療的ⅢA-N 2期非小細胞肺癌（NSCLC）患者預後的因素，併分析不同亞組的生存率差異。方法迴顧中日友好醫院2001年1月至2013年12月期間行肺癌根治術，併經病理證實為ⅢA-N 2期的92例NSCLC患者的臨床病理資料。分析可能影響預後的因素，併用Kaplan-Meier麯線及Log-rank檢驗分析生存率差異，用Cox比例風險迴歸模型分析各因素對生存率的影響。結果單因素分析顯示，組織學類型（P=0.001）、術後治療（P=0.011）、縱隔淋巴結轉移數量＞3（P=0.010）、縱隔淋巴結跨區域轉移（P=0.010）、縱隔淋巴結多區域轉移（P=0.013）是影響生存率的因素；多因素分析顯示縱隔淋巴結轉移數量＞3（P=0.007）和跨區域轉移（P=0.046）是影響預後的獨立危險因素。原髮腫瘤在左肺下葉、右肺下葉者最易齣現跨區域轉移，髮生率分彆為53.3%和48.0%；其次是左肺上葉（31.6%）、右肺中葉（14.3%）和右肺上葉（11.5%）。結論縱隔淋巴跨區域轉移和縱隔淋巴結轉移數量＞3是獨立的生存預後因素，作為ⅢA-N2期NSCLC的一種亞組特徵，提示腫瘤侵襲性更高和預後不良。任何部位的肺癌均可髮生縱隔淋巴結跨區域轉移，下葉肺癌的跨區域轉移髮生率最高。
목적：탐토영향근치성수술치료적ⅢA-N 2기비소세포폐암（NSCLC）환자예후적인소，병분석불동아조적생존솔차이。방법회고중일우호의원2001년1월지2013년12월기간행폐암근치술，병경병리증실위ⅢA-N 2기적92례NSCLC환자적림상병리자료。분석가능영향예후적인소，병용Kaplan-Meier곡선급Log-rank검험분석생존솔차이，용Cox비례풍험회귀모형분석각인소대생존솔적영향。결과단인소분석현시，조직학류형（P=0.001）、술후치료（P=0.011）、종격림파결전이수량＞3（P=0.010）、종격림파결과구역전이（P=0.010）、종격림파결다구역전이（P=0.013）시영향생존솔적인소；다인소분석현시종격림파결전이수량＞3（P=0.007）화과구역전이（P=0.046）시영향예후적독립위험인소。원발종류재좌폐하협、우폐하협자최역출현과구역전이，발생솔분별위53.3%화48.0%；기차시좌폐상협（31.6%）、우폐중협（14.3%）화우폐상협（11.5%）。결론종격림파과구역전이화종격림파결전이수량＞3시독립적생존예후인소，작위ⅢA-N2기NSCLC적일충아조특정，제시종류침습성경고화예후불량。임하부위적폐암균가발생종격림파결과구역전이，하협폐암적과구역전이발생솔최고。
Objective To investigate the prognostic factors for patients underwent curative resection of stageⅢA-N2 non-small cell lung cancer (NSCLC), and analyze the difference between subgroups.Methods The clinicopathological data of 92 patients who underwent curative resection for NSCLC and pathologically diagnosed as stageⅢA-N2 were reviewed retrospectively. The characteristics were analyzed to identify the prognostic factors, the Kaplan-Meier method and Log-rank test were used to analyze the relationship between the variables and the prognosis in univariate analysis. The Cox proportional hazard regression model was used to make multivariate analysis.Results In univariate analysis, the factors that affect survival were histology (P=0.001), postoperative therapy (P=0.011), MLN metastasis >3 (P=0.010), trans-regional MLN metastasis (P=0.010), multiple MLN zones metastasis (P=0.013). A multivariate analysis using Cox regression identified 2 independent factors of prognosis: MLN metastasis >3 (P=0.007) and trans-regional MLN metastasis (P=0.046). The incidence of trans-regional MLN metastasis were higher in patients with primary tumor in the left lower lobe (53.3%) or right lower lobe (48.0%), followed by left upper lobe (31.6%), right middle lobe (14.3%) and right upper lobe (11.5%).Conclusion Trans-regional MLN metastasis and MLN metastasis >3 are independent prognostic factors for the survival of stageⅢA-N2NSCLC, as particular characteristics for classification of the subgroups, these patterns indicate more aggressive disease and poor prognosis. Trans-regional MLN metastasis could occur with primary tumor in any lobe but more frequently in the lower lobe.
