肺鳞癌与腺癌非手术治疗预后差异的原因分析

目的分析非手术治疗的肺鳞癌与腺癌预后差异的原因。方法１９９０年１２月～１９９４年１２月间以根治性放疗为主的非手术治疗１７７例肺癌（鳞癌１２５例，腺癌５２例），采用Ｋａｐｌａｎ－Ｍｅｔｅｒ计算方法和Ｃｏｘ多因素分析方法分析鳞癌和腺癌的生存率、肿瘤局部控制率、无远处转移率，并进行比较。结果１年和２年生存率，肺鳞癌为８０．３％和４４％，显著高于腺癌的５５．４％和１７．２％（Ｐ＜０．００１）；１年和２年局部控制率，肺鳞癌为７９．５％和４３．４％，肺腺癌为５４．３％和２７．６％（Ｐ＝０．００７）；１年和２年无远处转移率，肺鳞癌为８６％和７３．９％，腺癌为６２．８％和２２．９％（Ｐ＜０．００１）。Ｃｏｘ多因素分析结果表明组织学类型在生存率、局部控制率、无远处转移率三项指标中均有显著差异（产均＜０．０１）。结论在非手术治疗中，肺鳞癌较腺癌患者预后好；预后差异的原因在于鳞癌局部控制率高而远处转移率低。     

去甲长春花碱加顺铂联合治疗晚期非小细胞肺癌32例

我科从１９９７年１月至１９９９年１２月，采用去甲长春花碱（ＮＶＢ）加顺铂（ＤＤＰ）联合治疗晚期ＮＳＣＬＣ ３２例，现将结果报告如下。１ 材料与方法１．１ 病例选择 有病理或细胞学证实的ＮＳＣＬＣ，Ｋａｒｎｏｆｓｋｙ评分≥７０分，疗前肝肾功能及血象均正常，预计生存期 ＞３个月，有可测量的临床观察指标。１．２ 一般资料 共收治可评价晚期ＮＳＣＬＣ ３２例，均为Ⅲｂ~Ⅳ期患者，其中Ⅲｂ期１３例，Ⅳ期１９例。年龄３０~７０岁，中位年龄５７岁。初治８例，复治２４例。腺癌１５例，鳞癌１６例，腺鳞癌１例。１．３ 给药方…     

放射治疗192例非小细胞肺癌的预后因子分析

对１９２例非小细胞肺癌（ＮＳＣＬＣ）接受以放射治疗为主的非手术根治性治疗后，研究有影响的预后因子。方法采用单因素分析和ＣＯＸ多因素模型分析。结果病期早者，鳞癌患者，采用非常规分割放疗者，放疗结束时即期疗效好者，其生存预后好。在各分组中，一、二年生存率为：鳞癌患者８０．３％，４３．６％，非鳞癌患者６２．４％，３２．１％（Ｐ＝０．００５）；Ⅰ＋Ⅱ期８２．４％，６４．２％，Ⅲａ７８．２％，４２．９％，Ⅲｂ６３．８％，２６．８％（Ｐ＝０．００３）；常规放疗６９．３％，２９．０％，超分割７６．４％，４１．４％，加速超分割７８．２％，５４．０％（Ｐ＝０．０１１）；即期疗效完缓解者８１．１％，５７．４％，部分缓解者８０．１％，４２．２％，无变化或进展者５２．５％，１８．３％（Ｐ＜０．００１）。结论病理类型，病期，放射治疗方法，放疗结束时即期疗效为独立的预后因子。     

T1～4N0M0期非小细胞肺癌根治术后是否需要辅助治疗

目的　探讨非小细胞肺癌（ Ｎ Ｓ Ｃ Ｌ Ｃ） Ｎ０ Ｍ０ 期根治术后不同病理及不同 Ｔ 分期的转归及治疗。方法　行根治术后病理为 Ｎ Ｓ Ｃ Ｌ Ｃ 的 Ｔ１ ～４ Ｎ０ Ｍ０ 期３５４ 例。男性２８５ 例,女性６９ 例。鳞癌１９１例,腺癌１６３ 例。鳞癌中 Ｔ１ Ｎ０ Ｍ０ 期２７ 例, Ｔ２ Ｎ０ Ｍ０ 期１３４ 例, Ｔ３ Ｎ０ Ｍ０ 期２８ 例, Ｔ４ Ｎ０ Ｍ０ 期２ 例。腺癌中 Ｔ１ Ｎ０ Ｍ０ 期４２ 例, Ｔ２ Ｎ０ Ｍ０ 期１０８ 例, Ｔ３ Ｎ０ Ｍ０ 期１０ 例, Ｔ４ Ｎ０ Ｍ０ 期３ 例。结果　全组５ 年生存率为５３ ．７ ％ ,鳞癌为５９ ．７ ％ ,腺癌为４６ ．６ ％ 。鳞癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为７０ ．４ ％ ,６４ ．９ ％ ,２８ ．６ ％ 及０／２（ Ｐ＜ ０ ．０５） ;局部复发率分别为１４ ．８ ％ ,９ ．７ ％ ,２１ ．４ ％ 及０／２（ Ｐ＞ ０ ．０５） ;远地转移率分别为１１ ．１ ％ ,２３ ．９ ％ ,５０ ．０ ％ 及２／２（ Ｐ＜ ０ ．０５） 。腺癌中 Ｔ１ Ｎ０ Ｍ０ ～ Ｔ４ Ｎ０ Ｍ０ 期５ 年生存率分别为６１ ．９ ％ ,４４ ．４ ％ ,２０ ．０ ％ 及０／３（ Ｐ＜ ０ ．０５） ;局部复发率     

胃癌术后化疗对患者外周血像及免疫指标的影响

２０例胃癌病人根治术后化疗前血像及免疫指标接近正常人水平，但化疗后上述指标下降非常显著（Ｐ＝０．０５～Ｐ＜０．００１）；且年轻胃癌组较年老组下降幅度更明显（ＷＢＣ：３．２±１．０×１０９／Ｌ对２．１±１．０×１０９／Ｌ，Ｐ＜０．０５；ＮＫ活性１２１．５±１２．７％对１３．５±１３．７％，但Ｐ＞０．０５）．提示年轻胃癌患者对化疗耐受性差。术后早期应开展免疫监视和进行免疫治疗。     

加速超分割放射治疗非小细胞肺癌初期疗效观察

目的观察加速超分割放射（ＨＡＲＴ）治疗非小细胞肺癌（ＮＳＣＬＣ）的即期疗效及早期放射反应。方法６３例ＮＳＣＬＣ入选ＨＡＲＴ组，取同期常规治疗７７例作为对照组（ＣＦ组）。ＨＡＲＴ组放射，每次１．１０Ｇｙ（±０．０２Ｇｙ），每天３次，每周５天，肿瘤灶总剂量为７２～７６Ｇｙ／６６～６９次／３３天（２９～４２天）。ＣＦ组每天１次，每周５天，总剂量为６２～６５Ｇｙ／３２～３６次／４８天（１２～５２天）。中位总疗程时间，ＨＡＲＴ较ＣＦ短１５天。结果ＨＡＲＴ组有３例不能耐受而终止放疗，８７％有放射性食管炎，而ＣＦ组仅５８％（Ｐ＝０．００１），原发灶完全缓解＋部分缓解（ＣＲ＋ＰＲ）为８０％，而ＣＦ组为５８％（Ｐ＝０．０２７）。结论ＨＡＲＴ为患者能耐受新的非常规分割方法，能提高ＮＳＣＬＣ的即期疗效。     

ras和erbB2基因在肺癌中的表达及意义

目的：了解ｒａｓ和ｅｒｂＢ２基因在肺癌中表达的临床意义。方法：采用免疫组化技术研究了ｒａｓｐ２１和ｅｒｂＢ２ｐ１８５在４０例肺癌（腺癌１９例，鳞癌１８例，腺鳞癌１例，小细胞肺癌２例）中的表达，并将肺癌按临床病理特征分组进行对比分析。结果：①在非小细胞肺癌（ＮＳＣＬＣ）中，ｐ２１的阳性率为６１％，ｐ１８５的阳性率为４２％，２例小细胞肺癌（ＳＣＬＣ）均无ｐ２１和ｐ１８５的表达。②ｐ１８５在肺腺癌中的表达明显高于鳞癌（Ｐ＜０．０５）。③在ＮＳＣＬＣ中，ｐ２１在Ⅰ～Ⅱ期中的阳性率为２５％，Ⅲａ～Ⅲｂ期中的阳性率为７７％，两者有非常显著的差异（Ｐ＜０．０１）。④ｐ２１和ｐ１８５阳性的ＳＮＣＬＣ患者，其淋巴结转移发生早，速度快（Ｐ＜０．０５）。⑤ｐ１８５在ＳＮＣＬＣ中的表达存在性别差异，女性明显高于男性（Ｐ＜０．０１）。结论：ｒａｓ和ｅｒｂＢ在ＮＳＣＬＣ中的表达具有重要的临床意义。     

VP方案与MVP方案治疗非小细胞肺癌的疗效比较

目的；比较ＶＰ方案与ＭＶＰ方案对非小细胞肺癌（ＮＳＣＬＣ）的治疗效果。方法：７８例患者分别用ＶＰ（ＶＤＳ＋ＤＤＰ）方案和ＭＶＰ（ＭＭＣ＋ＶＰ）方案治疗。结果：ＶＰ组和ＭＶＰ组有效分别为４５．７％和４７．２％，两者无显著怀差异。分析诸因素对疗效的影响发现，病期早较病期晚疗效好。生活质量评估Ｋａｍｏｆｓｋｙ评分一升高为７１．４％，ＭＶＰ组为６９．４％，两组无显著性差异。骨髓抑制为限制性毒性，白细胞下降     

ＩＬ-６致非小细胞肺癌 ＰＤ-１抑制剂治疗抵抗的效应和机制研究

目的：通过回顾性分析晚期非小细胞肺癌（ｎｏｎ ｓｍａｌｌｃｅｌｌｌｕｎｇｃａｎｃｅｒ,ＮＳＣＬＣ）患者外周血白细胞介素 ６（ｉｎ ｔｅｒｌｅｕｋｉｎ６,ＩＬ ６）水平与程序性细胞死亡蛋白 １（ｐｒｏｇｒａｍｍｅｄｃｅｌｌｄｅａｔｈｐｒｏｔｅｉｎ １,ＰＤ １）抑制剂疗效的相关性,初步探 讨 ＩＬ ６致 ＰＤ １抑制剂治疗抵抗的效应和机制。方法：纳入接受 ＰＤ １抑制剂治疗且有治疗前外周血 ＩＬ ６检测结果 的晚期 ＮＳＣＬＣ患者,分析 ＩＬ ６水平与客观缓解率（ｏｂｊｅｃｔｉｖｅｒｅｓｐｏｎｓｅｒａｔｅ,ＯＲＲ）、持续临床获益（ｄｕｒａｂｌｅｃｌｉｎｉｃａｌｂｅｎｅ ｆｉｔ,ＤＣＢ）、无持续临床获益（ｎｏｎ ｄｕｒａｂｌｅｃｌｉｎｉｃａｌｂｅｎｅｆｉｔ,ＮＤＢ）的相关性。通过 ＣＣＫ ８及 Ｋｉ６７实验检测 ＩＬ ６对 Ｔ细胞 杀伤肿瘤细胞效应的影响,Ｗｅｓｔｅｒｎｂｌｏｔ检测目的蛋白的表达情况。结果：３０例晚期 ＮＳＣＬＣ患者中 ＤＣＢ组 ＩＬ ６水平 显著低于 ＮＤＢ组（中位值 ４．６０ｐｇ／ｍＬｖｓ１２．８８ｐｇ／ｍＬ,Ｐ＝０．００２）。低 ＩＬ ６组（＜７ｐｇ／ｍＬ,ｎ＝１０）与高 ＩＬ ６组（≥７ ｐｇ／ｍＬ,ｎ＝２０）相比,ＤＣＢ占比更大（１００％ ｖｓ５０％,Ｐ＝０．００２）,ＯＲＲ更高（６５％ ｖｓ２０％,Ｐ＝０．０２５）,中位无进展生存 期更长（未达到 ｖｓ８个月,Ｐ＝０．００７）。ＣＣＫ ８及 Ｋｉ６７检测结果示,外加 ＩＬ ６可显著抑制 Ｔ细胞对 Ｈ１２９９、Ａ５４９细胞 的杀伤效果。Ｗｅｓｔｅｒｎｂｌｏｔ检测发现,外加 ＩＬ ６可显著上调 ｐ ＳＴＡＴ３、ｐ ＡＫＴ水平,并显著下调 ＳＴＩＮＧ和 ｐ-ＴＢＫ１表 达。结论：外周血 ＩＬ-６水平与晚期 ＮＳＣＬＣ患者 ＰＤ-１抑制剂治疗效果显著负相关。ＩＬ-６可能通过活化 ＳＴＡＴ３-ＡＫＴ 通路进而抑制 ＳＴＩＮＧ-ＴＢＫ１信号,减弱 Ｔ淋巴细胞对肿瘤细胞的杀伤。     

老年晚期非小细胞肺癌患者免疫治疗的疗效和安全性

目的：评价老年晚期非小细胞肺癌（ｎｏｎ ｓｍａｌｌｃｅｌｌｌｕｎｇｃａｎｃｅｒ,ＮＳＣＬＣ）患者接受免疫检查点抑制剂治疗的 疗效和安全性,探索疗效和预后相关生物标志物。方法：回顾性收集 ２０１８年 ３月至 ２０２１年 １０月于中国 ３家医院接 受免疫治疗的老年晚期 ＮＳＣＬＣ患者资料,对免疫治疗的疗效和安全性进行评估,应用 Ｋａｐｌａｎ Ｍｅｉｅｒ法和 Ｌｏｇ ｒａｎｋ检 验进行生存分析,并采用单因素及多因素 Ｃｏｘ风险比例回归模型、ｔ ｔｅｓｔ来检验各项临床特征和实验室指标与生存的 相关性。结果：研究共纳入 １０２例患者,客观缓解率为 ４１．０２％,疾病控制率为 ８８．４６％,中位无进展生存时间（ｐｒｏ ｇｒｅｓｓｉｏｎ ｆｒｅｅｓｕｒｖｉｖａｌ,ＰＦＳ）为 ７．５个月,中位总生存时间（ｏｖｅｒａｌｌｓｕｒｖｉｖａｌ,ＯＳ）为 ２２．０个月。单因素分析显示,ＥＣＯＧ ＰＳ评分 ０～１分（Ｐ＝０．０４１）、无肝转移（Ｐ＝０．０４８）和一线治疗（Ｐ＝０．０４７）与更长的 ＰＦＳ显著相关,吸烟史（Ｐ＝ ００１０）、无脑转移（Ｐ＜０．００１）与更长的 ＯＳ显著相关。多因素分析显示,ＥＣＯＧＰＳ评分≥２分患者的 ＰＦＳ（Ｐ＝ ０００１）和 ＯＳ（Ｐ＜０．００１）明显短于 ０～１分者,联合治疗组的 ＰＦＳ明显长于单药治疗组（Ｐ＝０．０３１）,脑转移患者的 ＯＳ明显短于不伴脑转移者（Ｐ＝０．０１７）。４８例（４７．０６％）患者在接受免疫治疗时出现不良事件,其中 ２１例 （２０５９％）患者出现≥３级不良事件。预后不佳组患者的基线期血红蛋白（Ｐ＝０．０２６）、白蛋白（Ｐ＝００２５）水平较预 后良好组显著降低。结论：老年晚期 ＮＳＣＬＣ患者接受免疫检查点抑制剂治疗的疗效和安全性良好,ＥＣＯＧＰＳ评分 ０～１分、有吸烟史、一线及联合治疗的患者可能是免疫治疗的潜在优势人群,基线期白蛋白、血红蛋白水平降低可能 预示着免疫治疗效果不佳。     

Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases

Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.     

Primary liposarcoma of the lung: Report of a case

We reported one case of a primary liposarcoma of the lung which has been reported only in six cases to date worldwide, and we added some documented study. A 49-year-old female complained of exertional dyspnea with about 100 ml of hemoptysis. The chest X ray showed a coin lesion at the left upper field. After left pneumonectomy, the histological examination revealed liposarcoma of the lung. Six months after the operation, she died from severe dyspnea; the autopsy revealed the relapse of liposarcoma in the right lung, and no liposarcomas in other organs. This is the seventh case according to a worldwide review of the literature.     

Amylase-producing lung cancer

A bronchioloalveolar carcinoma of lung associated with hyperamylasemia occurring in a 40-year-old woman is described. Another 13 cases of such a tumor from the English literature are reviewed. A majority of the lung tumors associated with hyperamylasemia were adenocarcinomas. When the amylase isoenzymes were determined, the amylase appeared to be salivary-gland type (S-type). Electron microscopic studies had revealed membrane-bound electron-dense granules within the tumor cells.     

Lymphadenectomy during pulmonary metastasectomy: Impact on survival and recurrence

Background and Objectives: Lymphadenectomy during pulmonary metastasectomy (PM) is widely carried out. We assessed the potential benefit on patient survival and tumor recurrence of this practice. Methods: One hundred eighty-one patients undergoing a first PM were studied. Eighty-six patients (47.5%) underwent lymphadenectomy (L+ group) whereas 95 (52.5%) did not undergo nodal harvesting (L−group). Main outcomes were overall survival (OS) and disease-free survival (DFS). Median follow-up was 25 months (interquartile range [IQR], 13-49). Results: At follow-up 84 patients (46.4%) died, whereas 97 (53.6%) were still alive with recurrence in 78 patients (43%). There was no difference in 5-year survival (L+ 30.0% vs L− 43.2%; P = .87) or in the 5-year cumulative incidence of recurrence (L + 63.2% vs L−80%; P = .07) between the two groups. Multivariable analysis indicated that disease-free interval (DFI) less than 29 months (P < .001) and lung comorbidities (P = .003) were significant predictors of death. Metastases from non-small–cell lung cancer increased the risk of lung comorbidities by a factor of 19.8, whereas the risk of DFI less than 29 months was increased nearly 11-fold. Competing risk regression identified multiple metastases (P = .004), head/neck primary tumor (P = .009), and age less than 67 years (P = .024) as independent risk factors for recurrence. Conclusion: Associated lymphadenectomy showed not to give any additional advantage in terms of survival and recurrence after PM.     

Bleomycin-associated pulmonary fibrosis: rapidly fatal progression without chest radiotherapy

Two patients with carcinoma of the tonsil were treated with bleomycin (396 and 224 units, respectively) but not with radiotherapy. Respiratory insufficiency led to death 45 and 52 days, respectively, after onset of therapy. Chest radiographs before bleomycin therapy revealed no evidence for lung disease. Postmortem examinations showed severe interstitial and intraalveolar pulmonary fibrosis. Comparably rapid progression from radiographically normal pulmonary parenchyma to fatal fibrosis has been documented previously only in patients with thoracic neoplasia as well as, in all but one instance, either prior or concurrent chest radiotherapy. These two cases indicate that chest radiotherapy is not a necessary cofactor for the development of rapidly progressive, fatal, diffuse interstitial pulmonary fibrosis after bleomycin therapy.     

NaPi2b expression in a large surgical Non-Small Cell Lung Cancer (NSCLC) cohort

BackgroundNaPi2b is a multi-transmembrane sodium-dependent phosphate transporter expressed at normal levels in several organs, including lung. High expression levels have been reported in various tumors including breast, thyroid, ovarian and non-small cell lung cancer. To date evaluation of NaPi2b expression has mostly been restricted to smaller lung cancer cohorts.MethodsAnalyses were performed on archival formalin fixed paraffin embedded primary tumor specimens from patients who had undergone curative intent resection at an Australian tertiary hospital. Tissue microarrays were constructed and stained with the chimeric anti-NaPi2b antibody, MERS67. Semi-quantitative H-scores (range 0 – 300) were calculated for each core tissue sample (H-score = % tumor cells staining for NaPi2b multiplied by staining intensity). An overall average H-score was reported for each specimen, with a cut-off score of 50 considered positive.ResultsOf 438 cases, high NaPi2b expression was observed in 151 (34.5%) overall, high expression in 137 of 208 (65.9%) adenocarcinoma cases, and 5 of 179 (2.8%) squamous cases (P < .0001). High NaPi2b expression was associated with female sex, EGFR or KRAS mutation, and TTF1 positivity (adenocarcinoma cases only). High NaPi2b expression was associated with improved overall survival (median 54 vs. 35 months, P = .029).ConclusionHigh NaPi2b expression was noted in a significant subset of adenocarcinoma cases, and in particular amongst those who were TTF1+, or exhibited EGFR or KRAS mutations. This agrees with earlier reports and highlights the significance that NaPi2b may have a role as a possible target for delivery of cytotoxic agents via antibody-drug conjugate models for some patients with lung adenocarcinoma.     

Importance of biologic status to the postoperative prognosis of patients with stage III nonsmall cell lung cancer

The prognosis of patients with stage III nonsmall cell lung cancer was studied, with special attention to their biologic status prior to lung resection. The biologic status was estimated from the neutrophil/lymphocyte ratio in the peripheral blood, serum albumin level, and erythrocyte sedimentation rate. Among 46 patients who underwent potentially curative operations, 31 cases of biologic status A or B (more than two parameters normal) revealed 37.6% of a 5-year survival rate, whereas there was no 5-year survivor in 15 cases of biologic status C or D (more than two parameters abnormal). Of the 5-year survival rate in T3N0 disease of biologic status A or B, the 60% surviving (of 10 cases) was in marked contrast to the same stage disease of biologic status C or D where only 1 patient (of 10 cases) was still surviving at more than 30 months. In 30 patients with T3N0, T3N1, and T2N2 diseases of biologic status A or B, where long-term survivors were derived, the 5-year survival rate in 30 patients of biologic status A or B was 36.6% in contrast to no long-term survivor in the same stage diseases of biologic status C or D (n = 25). We conclude that surgical results in stage III nonsmall cell lung cancer will be beneficial in patients of biologic status A or B, but nonbeneficial in patients with the same stage of biologic status C or D.     

电视辅助胸腔镜肺叶切除术治疗非小细胞肺癌的疗效观察

目的 比较电视胸腔镜下肺叶切除与开胸肺叶切除治疗早期非小细胞肺癌的临床效果.方法 收集81例初诊为早期非小细胞肺癌实施手术治疗的患者为研究对象,并将其分为2组:观察组和对照组.观察组给予胸腔镜肺叶切除术,对照组给予开胸肺叶切除术.比较2组患者手术时间、术中出血、术后拔管时间、住院时间及术后并发症情况.定期随访,比较患者术后3个月、6个月、12个月及3年的生活质量及3年生存率.结果 2组患者的手术时间、拔管时间无明显差异(P>0.05),但观察组患者术中出血及住院时间明显低于对照组(P<0.05).观察组患者有7例出现肺部感染,并发症发生率17.1%;对照组患者并发症合计16例,并发症发生率为40.0%.观察组并发症发生率明显低于对照组(P=0.022).术后第3个月、6个月观察组患者的生存质量明显高于对照组(P<0.05),术后第12个月2组患者的生存质量无明显差异(P>0.05).观察组3年生存率为29.3%,对照组的生存率为30.0%,差异无统计学意义(P=0.994).结论 电视胸腔镜下肺叶切除术治疗非小细胞肺癌,手术创伤小,术中出血少,术后并发症少,术后生存质量高,术后3年生存率与开胸肺叶切除术无明显差异,近期效果满意.     

逆行肺切除在肺癌继发肺脓肿治疗中的应用

目的:探讨逆行肺切除在肺癌继发肺脓肿治疗中应用的可行性。方法:回顾性分析16例肺癌继发肺脓肿患者术中采用逆行肺切除术,即先处理支气管后处理肺血管的临床资料。结果:全组无围手术期死亡,恢复良好。结论:逆行肺切除在肺癌继发肺脓肿外科治疗中是可行的。     

诱导性同步放化疗治疗侵袭性肺上沟瘤

目的分析同步放化疗(CRT)在NSCLC外科治疗的地位.方法回顾性总结1987～1996年外科手术的30例累及胸顶部的NSCLC,单纯手术组10例,手术+放疗组(RT)9例,含铂方案化疗+放疗组(CRT)11例.结果单纯手术组2、4年生存率分别为30%和20%, RT组为22% 和11%,CRT组为73% 和53%.单因素分析根治性(是与否比较,P=0.027)和诱导性治疗(单纯手术和RT与CRT比较,P=0.0173)是有意义的预后因素.多因素分析仅诱导性治疗,P=0.023 8,是有意义的预后因素.结论与诱导性放疗和单纯手术相比,CRT可提高累及胸顶部的NSCLC患者的生存率.