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目的 探讨术前新辅助化疗加外科手术治疗Ⅲ期非小细胞肺癌的可行性和毒性反应 ,同时评价其有效性以及在病期下调率、提高切除率和患者生存率中的作用。方法 从 1990年 1月～ 2 0 0 1年 1月 ,对62 4例Ⅲ期非小细胞肺癌进行前瞻性随机对照试验 ,其中 314例被随机分入术前新辅助化疗组 (试验组 ) ,行术前化疗 2个周期 ,其中 2 1例行支气管动脉介入化疗 ,68例接受MVP方案 ,36例CAP方案 ,67例EP方案 ,2 0例VIP方案 ,30例Gem +DDP方案 ,32例NVB +DDP方案 ,30例Taxol+NVB方案 ,10例Taxol +DDP方案化疗。化疗结束后施行手术治疗。 310例被随机分入对照组的患者 ,则先行手术治疗。对两组P N1 2 的患者术后均给予 5 0～ 5 5Gy的胸部放疗。结果 术前新辅助化疗的有效率为 73.5 7% ( 2 31/314 ) ,病期下调率为 43.63%( 137/314 ) ,病理组织学完全缓解率为 15 .92 % ( 5 0 /314 )。手术切除率试验组为 97.69% ,对照组为 91.94%。两组手术失血量、手术并发症和手术死亡率比较均无显著性差异 (P >0 .0 5 )。新辅助化疗组术后 1、3、5、10年生存率分别为 89.35 %、67.46%、34 .39%和 2 9.34 % ,对照组分别为 87.5 3%、5 1.5 4%、2 4.19%和 2 1.64 %。试验组术后生存率显著高于对照组 (P <0 .0 1)。结论 术前新辅助?
Objective To investigate the feasibility and toxicity of preoperative neoadjuvant chemotherapy plus surgical treatment for stage III non-small cell lung cancer, and to evaluate its effectiveness and role in reducing the rate of disease, increasing the resection rate and the survival rate of patients. Methods From January 1990 to January 2001, prospective randomized controlled trials were conducted on 624 patients with stage III non-small cell lung cancer, of whom 314 were randomly assigned to preoperative neoadjuvant chemotherapy (experimental group). Preoperative chemotherapy 2 cycles, of which 21 patients underwent bronchial arterial chemoembolization, 68 underwent MVP regimen, 36 underwent CAP regimen, 67 underwent EP regimen, 20 underwent VIP regimen, 30 underwent Gem + DDP regimen, and 32 underwent NVB +DDP protocol, 30 cases of Taxol+NVB regimens, and 10 cases of Taxol+DDP chemotherapy. Surgical treatment is performed after the end of chemotherapy. When 310 patients were randomly assigned to the control group, surgery was performed first. Both groups of patients with P N1 2 received 50 to 55 Gy thoracic radiotherapy. Results The effective rate of preoperative neoadjuvant chemotherapy was 73.57% ( 2 31/314), the reduction rate of the disease was 43.63% (137/314), and the complete remission rate of histopathology was 15.92% ( 5 0 /314). . The surgical resection rate was 97.69% in the test group and 91.94% in the control group. There was no significant difference in blood loss, operative complications, and operative mortality between the two groups (P > 0.05). The 1-, 3-, 5-, and 10-year survival rates of the neoadjuvant chemotherapy group were 89.35 %, 67.46%, 34.39%, and 29.34%, respectively, and the control group was 87.5 3%, 5 1.54%, 2 4.19%, respectively. 2 1.64 %. The survival rate in the experimental group was significantly higher than that in the control group (P < 0.01). Conclusion Preoperative neoadjuvant?