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目的探讨非小细胞肺癌(NSCLC)患者标准淋巴结清扫术中阳性淋巴结比率(LNR)对其术后预后的影响。方法回顾性分析2010~2013年1月我院行肺癌根治术及系统性淋巴结清扫术432例肺癌患者的临床资料,其中男316例、女116例,年龄39~84(57.59±9.16)岁。432例患者中,229例(53.0%)为N0期,104例(24.1%)为N1期,99例(22.9%)为N2期。通过Kaplan-Meier曲线和COX多因素回归模型,评估临床资料与患者生存期之间的相关性。结果每例患者平均切除5(1~52)枚淋巴结。Kaplan-Meier生存曲线显示,阳性淋巴结分期越高的患者总生存期和无病生存期越短(P<0.001);生存分析表明,LNR与总生存期和无病生存期密切相关(P<0.001);COX多元分析确定阳性淋巴结比率是影响NSCLC预后的独立危险因素。结论 LNR是NSCLC的独立预后因子,可在今后的NSCLC分期标准中用于改进淋巴结分期。
Objective To investigate the effect of positive lymph node ratio (LNR) on the prognosis of patients with non-small cell lung cancer (NSCLC) after standard lymph node dissection. Methods The clinical data of 432 patients with lung cancer who underwent radical mastectomy and systemic lymphadenectomy in our hospital from January 2010 to January 2013 were retrospectively analyzed. There were 316 males and 116 females, aged 39-84 (57.59 ± 9.16) years. Of the 432 patients, 229 (53.0%) had N0, 104 (24.1%) had N1, and 99 (22.9%) had N2. Kaplan-Meier curves and COX multivariate regression models were used to assess the correlation between clinical data and patient survival. Results In each patient, 5 (1 ~ 52) lymph nodes were removed on average. Kaplan-Meier survival curves showed that patients with higher positive lymph node staging had shorter overall and disease-free survival (P <0.001). Survival analysis showed that LNR was closely associated with overall survival and disease-free survival (P <0.001 ). Cox multivariate analysis confirmed that the positive lymph node ratio was an independent risk factor for the prognosis of NSCLC. Conclusion LNR is an independent prognostic factor for NSCLC and can be used to improve lymph node staging in future NSCLC staging criteria.