Ⅲa期非小细胞肺癌新辅助化疗的疗效分析及应用价值

背景与目的 新辅助化疗应用于可手术切除的Ⅲa期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的确切疗效及安全性尚存争议.本研究旨在探讨新辅助化疗对可手术切除Ⅲa期NSCLC患者的近期疗效,并分析其与术后并发症的相关性.方法 根据纳入及排除标准,回顾性分析2011年1月-2013年10月重庆医科大学附属第一医院收治的明确临床诊断为Ⅲa期NSCLC 370例患者完整资料,根据术前是否接受新辅助化疗分为两组,其中A组为新辅助化疗+手术组97例,B组为直接手术组273例,比较两组患者的临床资料,分析新辅助化疗后肿瘤降期率,并将两组患者的手术情况、术后并发症进行对比,统计两组患者3年无病生存期(disease-free survival,DFS).结果 A组患者新辅助化疗后肿瘤总降期率为65.98%(64/97);两组患者R0切除率分别为96.91%(94/97)和90.48%(247/273),手术时间、术中出血量、术后平均住院日差异均无统计学意义(P>0.05);术后并发症总发生率A组稍高于B组,分别为76.29%(74/97)和72.52%(198/273),差异无统计学意义(P>0.05);所有患者术后随访2个月-36个月,中位随访时间12.7个月,两组患者术后总体复发转移率分别为63.92%(62/97)和94.87%(259/273),有统计学差异(P<0.05);A、B两组患者中位DFS分别为19.46个月和11.34个月,差异有统计学意义(P<0.001).结论 新辅助化疗可使Ⅲa期NSCLC患者受益,能有效降低肿瘤分期,提高肿瘤切除率,可降低术后局部复发率及远处转移率,提高患者的无进展生存期;且并不明显增加术后并发症的发生率.

Efficacy and Potential Application of Neoadjuvant Chemotherapy in Patients with Ⅲa Stage Non-small Cell Lung Cancer

Background and objective The therapeutic effect and side effect of neoadjuvant chemotherapy were still disputing issues when applied to resectable Ⅲa stage non-small cell lung cancer (NSCLC) patients. The retrospective analysis was aimed to investigate the short-term efficacy and postoperative complications in resectable Ⅲa NSCLC patients treated with neoadjuvant chemotherapy.Methods According to inclusion criteria and exclusion criteria, 370 patients with clinical diagnosis of ⅢaNSCLC were selected from our hospital between January 2011 and October 2013 were retrospectively analyzed. According to treatment method, group A (preoperative neoadjuvant chemotherapy+surgery group) contained 97 cases, and 273 patients were included in group B (direct surgery without neoadjuvant treatment group). The clinical data, surgi-cal approach, main postoperative complications and disease-free survival (DFS) among patients in two groups were recorded. Results The total down-staging in group A was 65.98% (64/97), the R0 resection in group A and group B were 96.91% (94/97) and 90.48% (247/273), respectively. The operation time, bleeding, postoperative hospitalization were no statistical difference (P>0.05), and the main postoperative complications of the patients in two groups were 76.29% (74/97) and 72.52% (198/273) (P>0.05). All patients followed-up for 2 months-36 months, the median follow-up time was 12.7 months, the total recurrence and metastasis rates were 63.92% (62/97) and 94.87% (259/273) (P<0.05) and the median DFS were 19.46 months and 11.34 months (P<0.001).Conclusion Neoadjuvant chemotherapy can benefit patients of Ⅲa stage NSCLC partly in down-staging T and N stage in tumor, enhance the R0 resection, but not significantly increased the postoperative complications of the patients, which can reduce the local recurrence and metastasis, enhance the DFS effectively.