CAJ | 학술논문

目的：评估影响淋巴结阴性Ⅰ～ⅡA期非小细胞肺癌的预后因素及辅助化疗疗效的因素。方法回顾性分析302例行根治性手术患者的临床资料。分析评估生存预后因素和有关辅助化疗的临床病理因素。结果近90％的患者接受肺叶切除或肺纵隔淋巴结切除术，其他患者行楔形切除。ⅠA期患者为35％，ⅠB期49％和ⅡA期16％。病理类型（P＝0．02），肿瘤直径（P＝0．01）和T分期（P＜0．001）为辅助化疗疗效的影响因素。同时，手术类型，淋巴管浸润（LVI），病理类型和复发是预测总生存期（OS）的重要因素；手术类型、T分期、LVI和胸膜入侵与无病生存率（PFS）相关。多因素分析显示手术类型（P＜0．001，HR：1．91）和复发（P＜0．001，HR：0．007）是OS的独立预后因素；胸膜入侵（P＝0．01，HR：0．57）和LVI（P＝0．004，HR：0．57）为PFS的独立预后因素。结论Ⅰ～ⅡA期淋巴结阴性非小细胞肺癌患者预后主要受到手术类型，淋巴管浸润（ LVI），组织学分级和复发情况的影响。
목적：평고영향림파결음성Ⅰ～ⅡA기비소세포폐암적예후인소급보조화료료효적인소。방법회고성분석302례행근치성수술환자적림상자료。분석평고생존예후인소화유관보조화료적림상병리인소。결과근90％적환자접수폐협절제혹폐종격림파결절제술，기타환자행설형절제。ⅠA기환자위35％，ⅠB기49％화ⅡA기16％。병리류형（P＝0．02），종류직경（P＝0．01）화T분기（P＜0．001）위보조화료료효적영향인소。동시，수술류형，림파관침윤（LVI），병리류형화복발시예측총생존기（OS）적중요인소；수술류형、T분기、LVI화흉막입침여무병생존솔（PFS）상관。다인소분석현시수술류형（P＜0．001，HR：1．91）화복발（P＜0．001，HR：0．007）시OS적독립예후인소；흉막입침（P＝0．01，HR：0．57）화LVI（P＝0．004，HR：0．57）위PFS적독립예후인소。결론Ⅰ～ⅡA기림파결음성비소세포폐암환자예후주요수도수술류형，림파관침윤（ LVI），조직학분급화복발정황적영향。
Objective To evaluate the prognostic factors and factors related with efficacy of adjuvant treatment for stageⅠand ⅡA non-small cell lung cancer ( NSCLC) .Methods Clinical data of 302 patients who had undergone curative surgery were retrospectively analyzed .Prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy were analyzed .Results Nearly 90%of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resec -tion.For the others,wedge resection were performed .The patients were diagnosed as stage ⅠA (35%),ⅠB (49%) and ⅡA (16%).Histopathological type (P=0.02),tumor diameter (P=0.01)and T stage (P<0.001)were found to be related to ad-juvant chemotherapy decisions .While operation type ,lypmhovascular invasion ( LVI) ,T stage and the presence of recurrence were important factors in predicting overall survival (OS).Operation type,T stage,LVI,and visceral pleural invasion were related with disease free survival.Multivariate analysis showed operation type (P<0.001,hazard ratio HR:1.91)and the presence of recur-rence (P<0.001,HR:0.007)were independent prognostic factors for OS,as well visceral pleural invasion (P=0.01,HR:0.57)and LVI (P=0.004,HR:0.57)for disease free survival.Conclusion Prognosis of stage ⅠandⅡA lymph node-negative NSCLC patients are mainly influenced by the type of surgery ,LVI,histological grade and recurrence .