新辅助化疗对165例Ⅲa期非小细胞肺癌患者术后生存的影响分析

 目的 探讨新辅助化疗对Ⅲa期非小细胞肺癌（NSCLC）生存率的影响，评价其安全性及可行性。方法 回顾性分析该院2000年1月至2004年1月外科完全性切除Ⅲa期NSCLC 165例临床资料，以新辅助化疗组（A组）与直接手术组（B组）进行对照。Life-Table法比较两组1、3、5年生存率差异，Kaplan-Meier法比较累计生存率及中位生存时间；COX多因素回归模型Condition-Forward法分析影响生存的主要因素。结果 两组患者术后1、3、5年生存率A组 80 %、30 %、13 %，B组 87 %、40 %、16 %；术后平均生存时间分别为25.5、29.4个月；中位生存期分别为20.0、25.0个月；差异有统计学意义（P＜0.05）。COX多因素分析表明病理类型、纵隔淋巴结转移状况、术前辅助化疗是影响Ⅲa期NSCLC预后的因素（P＜0.05）。结论 新辅助化疗+手术可延长生存期，新辅助化疗在一定程度上增加手术难度,但是安全可行的。

Effect of neoadjuvant chemotherapy on survival time in patients with stage Ⅲa non-small cell lung cancer, evaluation of 165 cases

Objective To study the safety and feasibility of neoadjuvant chemotherapy on operation in patients with stage ⅢA NSCLC. Methods 165 cases of NSCLC patient in Ⅲa stage treated with complete re－section from January 2000 to January 2004 in Xinjiang Tumor Hospital were reviewed retrospectively. Accord－ing to the treatment method, the patients were divided into group A (81 cases, control group without neoadju－vant chemotherapy) and group B(84 cases, preoperative neoadjuvant chemotherapy group). Life-table law com－pared the difference of survival rate of 1, 3, 5 years of two groups. Kaplan-Meier law compared the cumulate survival time, median time between two groups, (α=0.05); Condition-forward law of Cox multifactor regression model analysed the main factor influencing the survival time（α=0.05）. Results The 1, 3, 5 survival rate of post-operation NSCLC was 80 %, 30 %, 13 % in A group; 87 %, 40 %, 16 % in B group respectively. The average survival time of the two groups is 25.5(A group), 29.4(B group) months respectively; and the median survival time of the two groups was 20.0, 25.0 months respectively(P ＜0.05). The results of Cox multifactor analysis showed that the histopathology, metastasis state of mediastinal lymph node, the method of mediastinal lymph node resection were important risk factors influencing the 5-year survival time of NSCLC patients in Ⅲa stage. Conclusion Neoadjuvant chemotherapy+operation can prolong the survival time in resectable NSCLC patients with Ⅲa stage. Neoadjuvant chemotherapy increases the difficulty of operation in some de－gree, but it is still safe and feasible in patients with stage Ⅲa NSCLC.