CAJ | 학술논문

目的：探讨新辅助结合手术切除治疗ⅢA-N2期非小细胞肺癌的临床疗效。方法：收集2008年1月至2013年7月上海交通大学附属胸科医院收治的术前明确单侧纵隔淋巴结（且淋巴结短径≥1 cm）转移（ⅢA-N2期），经新辅助治疗后再手术的非小细胞肺癌（non-small cell lung cancer，NSCLC）91例患者。总结并分析经术前新辅助治疗的反应率以及患者的生存情况并分析影响预后的因素。结果：3年和5年总生存期（OS）分别为57.7%和34.2%；3年和5年无病生存期（DFS）分别为37.9%和30.5%。在OS和DFS方面，R0和R1组之间（P=0.118；P=0.369）、新辅助化疗和放化疗组之间（P=0.771；P=0.953）、临床反应和无反应组之间（P=0.865；P=0.862）以及不同组织病理类型组之间（P=0.685；P=0.208）比较差异均无统计学意义。肺叶切除及术后病理性淋巴结降期的患者分别优于相应地扩大性切除（P=0.023；P=0.024）和未降期（P=0.036；P=0.025）的患者。单因素分析显示肺叶切除和术后病理性淋巴结降期为有利的预测因子。多因素分析显示，病理淋巴结降期为术后DFS的有利预测因子；无吸烟史及肺叶切除为OS的有利预测因子。结论：术前新辅助治疗ⅢA-N2期NSCLC是可行的，能有效地使肿瘤大小及淋巴结降期，预后较为满意；预测预后方面，术后病理性降期要比临床反应更有意义；可行根治性肺叶切除及有病理性淋巴结降期的患者预后更好。
목적：탐토신보조결합수술절제치료ⅢA-N2기비소세포폐암적림상료효。방법：수집2008년1월지2013년7월상해교통대학부속흉과의원수치적술전명학단측종격림파결（차림파결단경≥1 cm）전이（ⅢA-N2기），경신보조치료후재수술적비소세포폐암（non-small cell lung cancer，NSCLC）91례환자。총결병분석경술전신보조치료적반응솔이급환자적생존정황병분석영향예후적인소。결과：3년화5년총생존기（OS）분별위57.7%화34.2%；3년화5년무병생존기（DFS）분별위37.9%화30.5%。재OS화DFS방면，R0화R1조지간（P=0.118；P=0.369）、신보조화료화방화료조지간（P=0.771；P=0.953）、림상반응화무반응조지간（P=0.865；P=0.862）이급불동조직병리류형조지간（P=0.685；P=0.208）비교차이균무통계학의의。폐협절제급술후병이성림파결강기적환자분별우우상응지확대성절제（P=0.023；P=0.024）화미강기（P=0.036；P=0.025）적환자。단인소분석현시폐협절제화술후병이성림파결강기위유리적예측인자。다인소분석현시，병리림파결강기위술후DFS적유리예측인자；무흡연사급폐협절제위OS적유리예측인자。결론：술전신보조치료ⅢA-N2기NSCLC시가행적，능유효지사종류대소급림파결강기，예후교위만의；예측예후방면，술후병이성강기요비림상반응경유의의；가행근치성폐협절제급유병이성림파결강기적환자예후경호。
Objective:This work presents the therapeutic advantage of induction therapy in patients withⅢA-N2 non-small cell lung cancer (ⅢA-N2 NSCLC). Methods:ⅢA-N2 NSCLC patients with ipsilateral mediastinal lymph node metastasis (>1 cm as shown by CT scan) who were admitted in our hospital between January 2008 and July 2013 were retrospectively analyzed. The response rates and survival outcomes of patients were presented and the prognostic factors were analyzed. Results:The 3-and 5-year overall survival (OS) rates were 57.7%and 34.2%, respectively, and the 3-and 5-year disease-free survival (DFS) rates were 37.9%and 30.5%, respec-tively. No significant differences in OS and DFS were observed between R0 and R1 resections (P=0.118; P=0.369), between groups who received neo-adjuvant chemo-radiotherapy and chemotherapy (P=0.771; P=0.953), between cases with and without clinical re-sponse (P=0.865;P=0.862), and among groups of different histological subtypes (P=0.685;P=0.208). However, patients with standard lobectomy or pathological nodal downstaging exhibited better OS (P=0.023 and P=0.024, respectively) and DFS (P=0.036 and P=0.025, respectively) than those who had extensive resections or persistent N2. Univariate analysis predicted better OS and DFS for both standard lobectomy and pathological nodal donwstaging. In addition, Cox multivariate analysis revealed that only pathological nodal downstaging could be considered as a favorable prognostic factor for DFS, while non-smoking and standard lobectomy are the corre-sponding variables for OS. Conclusion:Neo-adjuvant therapy with platinum-based doublet is feasible and useful in tumor and patho-logical nodal downstaging, which potentially improved resectability and survival rates in patients withⅢA-N2 NSCLC. Performing lo-bectomy or pathological nodal downstaging following induction therapy improved the patients' survival rate.