论文部分内容阅读
背景与目的:肺癌为当前最常见的恶性肿瘤之一,其中非小细胞肺癌(NSCLC)占绝大多数,而且大部分在诊断时已属晚期,对Ⅲ期估计不能全部切除的NSCLC,通过新辅助化疗可以使原发肿瘤缩小,提高手术切除率,消灭微小转移,延长NSCLC患者的生存率。所以本文目的在于探讨先化疗后手术对NSCLC预后因素的影响。方法:回顾性收集我院1995年~1997年先化疗后手术的Ⅰ~Ⅲ期NSCLC住院病例98例,其中Ⅰ期35例、Ⅱ期21例、Ⅲ期42例,手术前先进行1和2周期化疗的分别为83例和15例,化疗方案为MVP、MOP或MAP等,化疗缓解率(RR),部分缓解(PR)45例,稳定(SD)53例,手术方式为肺叶切除或全肺切除,分站摘除所有肉眼可见的胸内淋巴结,手术病理提示鳞癌35例、腺癌48例、混合型9例、其他6例,术后化疗2~3个周期(1996年后Ⅰ期NSCLC术后未作化疗)。对先化疗后手术的98例NSCLC患者的临床资料,随访5年以上,运用Kap lan-M e ier生存曲线分析,Log Rank检验和Cox多因素分析,对影响预后的因素进行单因素和多因素分析。结果:98例先化疗后手术NSCLC患者的中位随访时间为41.2月,其中36例存活,62例死亡。98例NSCLC患者的1年、3年、5年生存率分别是88.78%、49.63%、18.46%;Ⅰ、Ⅱ、Ⅲ期5年生存率分别为33.23%、20.26%、5.52%(P=0.0002);N0、N1、N2组5年生存率分别为35.49%、19.08%、4.90%(P=0.0004)。先化疗后手术NSCLC总分期越晚预后越差;术前末次化疗距手术时间为1月内预后好;全肺切除较肺叶切除预后差;肺门固定较肺门活动预后差;胸内淋巴结(+)预后差,N1较N0预后差,N2较N1预后更差;其它预后不良因素包括肿块侵犯大血管、脏器、胸壁、心包,术中出血量≥400m l,腺癌;化疗后肿块纤维化预后好。本组结果还显示:术前化疗2周期较术前化疗1周期预后好;肿瘤坏死和术后未行化疗者预后差。结论:影响先化疗后手术NSCLC患者的预后因素为:总分期、术前末次化疗距手术时间、术式、肺门活动度、胸内淋巴结、肿块侵犯部位、术中出血量、病理类型及肿瘤纤维化。术前化疗次数、肿瘤坏死和术后化疗亦可能是先化疗后手术NSCLC预后的影响因素。
BACKGROUND & OBJECTIVE: Lung cancer is currently one of the most common malignancies, of which non-small cell lung cancer (NSCLC) accounts for the vast majority, and most of them are advanced at the time of diagnosis. It is estimated that stage III NSCLC cannot be completely resected through new Adjuvant chemotherapy can shrink the primary tumor, increase the resection rate, eliminate micrometastases, and prolong the survival rate of NSCLC patients. Therefore, the purpose of this article is to investigate the effect of surgery after chemotherapy on the prognostic factors of NSCLC. METHODS: Ninety-eight patients with stage I to III NSCLC who underwent surgery after chemotherapy in our hospital from 1995 to 1997 were retrospectively reviewed. Among them, 35 patients in stage I, 21 in stage II, 42 in stage III, and 1 and 2 before surgery. There were 83 and 15 cycles of chemotherapy, chemotherapy, MVP, MOP or MAP, chemotherapy remission (RR), partial remission (PR) in 45 cases, and stability (SD) in 53 cases. The surgical approach was either lobectomy or Pneumonectomy, removal of all visible intrathoracic lymph nodes, surgical pathology suggest 35 cases of squamous cell carcinoma, adenocarcinoma 48 cases, mixed 9 cases, other 6 cases, postoperative chemotherapy 2 to 3 cycles (1996 post-I No chemotherapy was performed after NSCLC.) The clinical data of 98 NSCLC patients undergoing surgery after chemotherapy were followed up for more than 5 years. Kap lan-Meier survival curve analysis, Log Rank test, and Cox multivariate analysis were used to analyze the prognostic factors of univariate and multivariate factors. analysis. Results: The median follow-up time for 98 NSCLC patients after chemotherapy was 41.2 months, of which 36 survived and 62 died. The 1-, 3-, and 5-year survival rates of 98 NSCLC patients were 88.78%, 49.63%, and 18.46%, respectively; the 5-year survival rates of I, II, and III were 33.23%, 20.26%, and 5.52%, respectively (P=0.0002). The 5-year survival rates of the N0, N1, and N2 groups were 35.49%, 19.08%, and 4.90%, respectively (P=0.0004). The prognosis of NSCLC after chemotherapy is poorer after surgery. The prognosis is better when the time of surgery is less than 1 month before surgery. Pneumonectomy has poor prognosis compared with lobectomy; hilum fixation has poor prognosis compared with hilar activity; intrathoracic lymph nodes ( +) Poor prognosis, N1 prognosis worse than N0, N2 prognosis worse than N1; other poor prognosis factors include large invasive tumors, organs, chest wall, pericardium, intraoperative blood loss ≥ 400m l, adenocarcinoma; chemotherapy after chemotherapy The prognosis is good. The results of this group also showed that: 2 cycles of preoperative chemotherapy compared with preoperative chemotherapy 1 cycle has a good prognosis; tumor necrosis and poor prognosis after surgery without chemotherapy. Conclusion: The prognostic factors affecting patients undergoing chemotherapy after NSCLC after chemotherapy are: total stage, last surgery before surgery, operation time, surgical method, hilar activity, intrathoracic lymph nodes, tumor invasion sites, intraoperative blood loss, pathological types, and tumors. Fibrosis. The number of preoperative chemotherapy, tumor necrosis, and postoperative chemotherapy may also be the factors affecting the prognosis of surgical NSCLC after chemotherapy.