右肺PN2非小细胞肺癌术后无复发转移及预后因素探讨

 目的分析影响右肺PN2非小细胞肺癌术后无复发转移及预后的因素,探讨最佳治疗方案。方法分析1999年9月～2002年3月24例术后病理确诊的右肺PN2非小细胞肺癌,随机分为辅助化疗组(术前或术后)与直接手术组,手术均为完全性切除,采用右肺叶或右全肺+系统性纵隔淋巴结清扫术。术后标本采用免疫组化法行抑癌基因p53,癌基因HER2,表皮生长因子受体(EGFR)等基因表达检测。分析病理分型,手术方式,术前辅助治疗,基因表达,淋巴结转移区域,肺门淋巴结转移,最高纵隔淋巴结转移等因素对预后的影响。结果24例患者2年生存率46%。辅助化疗,EGFR为影响术后无复发转移的重要因素。KaplanMeier生存分析显示辅助化疗与生存有影响,多变量COX回归分析未发现影响预后的独立因素。结论以手术为主的综合治疗是右肺PN2非小细胞肺癌较好的治疗模式。EGFR高表达与术后复发转移有关,对此类患者术后是否应加用靶点治疗需进一步的研究。

The Exploration of The Recurrence-free and Prognostic Factors in Right Resected PN2 Non-small Cell Lung Cancer

Objective To explore the recurrence free and prognostic factors in right curatively resected PN2 non small cell lung cancer.Methods 24 PN2 right curatively resected NSCLC cases between 1999 and 2002 were randomizely divided into adjuvant chemotherapy(before or after operation) group and single operation group. The expression of p53,HER 2 and EGFR by immunohistochemistry was studied. The effects of pathology, operation style, adjuvant chemotherapy, expression of genes, multilevel involvement of mediastinal lymph nodes, metastasis of hilar lymph nodes or most superior mediastinal lymph node on prognosis were analyzed.Results The two year survival rate was 46%,adjuvant chemotherapy and expression of EGFR have important effects on postoperative recurrence and metastasis. Kaplan Meier analysis showed adjuvant chemotherapy wass related to survival ,however,no independent factor was found by COX analysis.Conclusion The treatment style of curative resection combined with adjuvant chemotherapy is reasonable for right pulmonary PN2 cases. High expression of EGFR is related to postoperative recurrence and metastasis, the target therapy should be concerned for these patients.