CAJ | 학술논문

目的：探讨影响N1期非小细胞肺癌（ NSCLC）患者预后的临床病理因素，比较分析意外性N1期（ cN0～pN1）和临床性N1期（ cN1～pN1） NSCLC患者的预后情况。方法回顾性分析2003年1月至2009年12月术后病理诊断为pT1～3N1M0期的183例NSCLC患者。其中意外性N1期78例，临床性N1期105例，比较两组患者的临床病理特征、中位生存时间、5年生存率和转移复发情况。结果意外性N1期组患者的T分期、肿瘤直径、淋巴结转移站数、淋巴结转移数量和手术方式与临床性N1期组比较，差异有统计学意义（ P＜0．05）。意外性N1期组患者的中位生存时间为47．0个月，1、3和5年生存率分别为85．9％、57．4％和42．5％。临床性N1期组患者的中位生存时间为30．0个月，1、3和5年生存率分别为74．3％、44．6％和28．8％。意外性N1期组患者的生存率明显优于临床性N1期组，差异有统计学意义（ P＝0．007）。意外性N1期组患者的局部复发率（10．3％）低于临床性N1期组（21．9％），差异有统计学意义（P＝0．038）。多因素分析结果显示，T分期、术前N分期、淋巴结转移站数和辅助化疗为N1期NSCLC患者的独立预后因素。结论不同临床表现的N1期NSCLC患者存在一定的异质性，意外性N1期NSCLC患者在远期生存和局部复发方面存在优势。
목적：탐토영향N1기비소세포폐암（ NSCLC）환자예후적림상병리인소，비교분석의외성N1기（ cN0～pN1）화림상성N1기（ cN1～pN1） NSCLC환자적예후정황。방법회고성분석2003년1월지2009년12월술후병리진단위pT1～3N1M0기적183례NSCLC환자。기중의외성N1기78례，림상성N1기105례，비교량조환자적림상병리특정、중위생존시간、5년생존솔화전이복발정황。결과의외성N1기조환자적T분기、종류직경、림파결전이참수、림파결전이수량화수술방식여림상성N1기조비교，차이유통계학의의（ P＜0．05）。의외성N1기조환자적중위생존시간위47．0개월，1、3화5년생존솔분별위85．9％、57．4％화42．5％。림상성N1기조환자적중위생존시간위30．0개월，1、3화5년생존솔분별위74．3％、44．6％화28．8％。의외성N1기조환자적생존솔명현우우림상성N1기조，차이유통계학의의（ P＝0．007）。의외성N1기조환자적국부복발솔（10．3％）저우림상성N1기조（21．9％），차이유통계학의의（P＝0．038）。다인소분석결과현시，T분기、술전N분기、림파결전이참수화보조화료위N1기NSCLC환자적독립예후인소。결론불동림상표현적N1기NSCLC환자존재일정적이질성，의외성N1기NSCLC환자재원기생존화국부복발방면존재우세。
Objective To investigate the prognosis of patients with N1 non-small cell lung cancer, and to compare the clinicopathological features and survival between patients with unexpected N1 ( cN0-pN1) and expected N1 disease ( cN1-pN1) after operation for non-small cell lung cancer.Methods This study retrospectively reviewed and analyzed the medical records of 183 patients who underwent surgery and pathologically diagnosed with N1 non-small cell lung cancer between January 2006 and December 2010. Among them, 78 patients had negative findings before surgery ( cN0-pN1 group ) , and 105 patients had positive findings before surgery ( cN1-pN1group ) .The clinicopathological features, median survival time and 5-year survival rates between the two groups were analyzed.Results Patients in the cN1-pN1 group had greater pathologic T stage, larger tumors, greater number and stations of positive N1 lymph nodes, and greater percentage of pneumonectomy than those in the cN0-pN1 group ( P<0.05) .For the patients with cN0-pN1, the MST was 47.0 months and the 1-, 3-, and 5-year OS were 85.9%, 57.4%, and 42.5%, respectively.For the patients with cN1-pN1, the MST was 30.0 months and the 1-, 3-,and 5-year OS were 74.3%, 44.6%, and 28.8%, respectively.There were significant differences in survival between the two groups ( P<0.05) .The locoregional recurrence rate of cN0-pN1 group was lower than in the cN1-pN1group ( P<0.05 ) .The multivariate analysis showed that T staging and N staging before surgery, lymph node metastasis to multiple N1 stations and adjuvant chemotherapy were independent prognostic factors. Conclusions Different clinical features of N1 non-small cell lung cancer has certain heterogeneity.Patients with unexpected N1 disease show better survival and lower locoregional recurrence rate than did those with expected N1 disease.