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N2期非小细胞肺癌的预后因素分析 总被引:1,自引:0,他引:1
目的 探讨有纵隔淋巴结转移(N2期)的非小细胞肺癌(NSCLC)的外科治疗疗效及影响预后的因素.方法 回顾性分析1999年1月至2003年5月手术治疗的117例N2 NSCLC患者(男性88例,女性29例,年龄29~79岁)的生存率,分析手术方式(肺叶切除、全肺切除、姑息性切除),病理类型(腺癌、鳞状细胞癌、混合癌、大细胞癌和其他类型),T分期以及术后综合治疗对预后的影响.结果 中位生存期为22个月,3年和5年生存率分别为28.1%和19.0%.年龄、性别、病理类型、围手术期化疗、术后放疗均未见与5年生存率有相关性.肺叶切除者的5年生存率为22.2%,全肺切除者为25.0%,均高于姑息性切除者的9.1%(P=0.001).T4期患者5年生存率为11.1%,低于T1-2期患者的37.5%(P=0.01).COX多因素分析示,手术方式和T分期与5年生存率相关.结论 外科治疗对T1-2 N2期NSCLC是最佳选择.对于T4期患者,由于不完全切除比例大,术前新辅助治疗比率低,手术提高长期生存率的效果有限. 相似文献
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Local therapy alone (surgery or radiation) leads to poor overall survival in patients with stage III non-small cell lung cancer because most of these patients die of distant metastases. During the past 20 years, studies have focused on developing effective chemotherapy regimens that can be combined with local therapies (surgery and/or radiation). The role of surgery has been evaluated, and the selection criteria for resection have been defined. 相似文献
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Ohkubo T Sugiura H Itoh K Ohno K Morikawa T Okushiba S Kondoh S Katoh H 《Kyobu geka. The Japanese journal of thoracic surgery》2001,54(1):80-85
In this study we analyzed 33 cases which underwent complete surgical resection to assess the role of surgery in the treatment of patients with N 2 NSCLC. The 3 year survival rate was 33.3% and the median survival time was 26.1 months. The survival curve for patients with T 3 factor was statistically worse than those with T 1 or T 2 factor. Further, the survival curve for patients with p 2 or p 3 factor was significantly lower than than that for those classified as p 0. Patients classified with p 2 or p 3 had a survival rate under 2 years. Only one patient diagnosed as T 3 achieved 3 year survival. This patient had a pm1 tumor with p 0 factor. We thereby recommend that surgery should only be performed for those N 2 NSCLC patients diagnosed as T 1 or T 2 with a classification of p1 or less. 相似文献
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Jazieh AR Kyasa MJ Sethuraman G Howington J 《The Journal of thoracic and cardiovascular surgery》2002,123(6):1173-1176
OBJECTIVES: The aim of our study was to identify the factors that determined whether a patient underwent surgery and its impact on patient outcome. METHODS: A retrospective evaluation of the records of all patients diagnosed with resectable stages I and II non-small cell lung cancer between 1990 and 1998 at the University of Arkansas and Veterans Administration Hospitals were included in the study. Demographic, clinical, pathologic, and outcome data were captured. Analysis was conducted to identify prognostic factors as well as factors leading to surgical treatment disparities. RESULTS: A total of 551 patients were included; 490 (89%) were men, 480 (87%) were white, and 315 (57%) were aged >65 years. Median follow-up of these patients was 24 months (1-109 months). Surgery was performed on 455 patients (82.6%); 26 patients received nonsurgical treatment including chemotherapy, radiation therapy, or both, and 70 patients did not receive any type of treatment. A univariate analysis revealed that age, race, sex, and forced expiratory volume in the first second were significantly different between the surgery and no surgery groups. However, a multivariate analysis showed that age, forced expiratory volume in 1 second, and hemoglobin were significantly different between both groups. The median overall survival was 45.5 months (1-109 months) for the surgically treated patients compared with 12.0 months (1-86 months) for those who did not undergo surgery (P <.0001). CONCLUSION: Elderly patients with early-stage non-small cell lung cancer are less likely to undergo a potentially curative surgical resection. Racial and sex disparities may be due to other comorbidities. 相似文献
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The prognosis of surgically resected N2 non-small cell lung cancer: the importance of clinical N status. 总被引:7,自引:0,他引:7
K Suzuki K Nagai J Yoshida M Nishimura K Takahashi Y Nishiwaki 《The Journal of thoracic and cardiovascular surgery》1999,118(1):145-153
BACKGROUND: Clinical trials dealing with multimodal strategy for N2 non-small cell lung cancer are now being watched with keen interest, and the feasibility of this strategy is to be confirmed. N2 lung cancer, however, is composed of several subgroups with different prognoses. The prognostic factors still remain controversial. METHODS: Between January 1986 and July 1997, 222 patients with lung cancer underwent surgical intervention at our institute; these patients were eventually given a diagnosis of metastasis to ipsilateral mediastinal lymph nodes. All patients underwent mediastinal lymph node dissection or sampling. Sixteen clinicopathologic factors were investigated by univariable and multivariable analyses to identify significant prognostic factors among resected N2 disease. Clinical N status was evaluated by computed tomographic scan. RESULTS: The overall 5-year survival was 27%. Multivariable analyses among overall patients revealed 4 significant prognostic factors (P <.05): clinical N2 status, incomplete resection, larger tumor size, and multiple diseased N2 nodes. Based on the result, 32 patients with both clinical N2 status and pathologic multiple N2 nodes showed a 5-year survival of 5%, whereas 76 patients with neither of the factors showed a 5-year survival of 57% (P <.001). CONCLUSION: The prognosis of surgically resected N2 disease varies tremendously according to the 4 significant prognostic factors. These factors should be clearly described in reporting clinical trials on N2 lung cancer. Clinical N status evaluated by computed tomographic scan should be 1 criterion to perform a clinical trial for N2 disease among a homogeneous population with respect to prognosis. 相似文献
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An analysis of results of operative treatment of 390 patients in 1980-1999 has shown growth of incidence of adenocarcinomas, less frequency of exploratory thoracotomies and non-radical resections of the lung, postoperative complications and lethality, more cases of 5-year survival. Reliable factors of prognosis of long-term results of treatment are established. 相似文献
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外科治疗ⅢA期N2非小细胞肺癌的预后分析及临床意义 总被引:7,自引:0,他引:7
目的 探讨影响ⅢA期N2非小细胞肺癌(NSCLC)预后的因素,并分析经手术治疗不同亚组病人的生存率差异。方法 分析1997年1月至2000年1月146例手术治疗的ⅢA期N2 NSCLC病人的可能影响预后因素:病理类型、肿瘤位置、肿瘤大小、手术方式、临床N2情况,N2转移组数及个数、术后辅助治疗等,并用Kaplan-Meier曲线及Logr ank检验生存率差异,Cox单因素、多因素分析各因素对生存率的影响。结果 ⅢA期N2 NSCLC病人的3年和5年生存率分别为19.86%和14.56%。单因素分析示肿瘤位置、临床N2情况、N2转移组数及个数是影响生存率的因素;多因素分析示肿瘤大小、临床N2情况,N2转移组数和肿瘤位置影响预后。右肺下叶肿瘤单组或单个N2转移,预后最好。结论 纵隔N2转移淋巴结的大小、个数和组数是影响术后生存率主要因素。手术前未发现N2转移(mN2),有1组N2转移(N2h),N2转移数少于4个者手术治疗效果好。右肺下叶肿瘤发生单组N2淋巴结转移预后好。 相似文献
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Nael Martini M.D. Betty J. Flehinger Ph.D. Muhammad B. Zaman M.D. Edward J. Beattie Jr. M.D. 《World journal of surgery》1981,5(5):663-666
Eighty patients were treated by resection for carcinoma of the lung with mediastinal lymph node metastases. Complete resection of the primary tumor and a mediastinal lymph node dissection were performed on all patients. The majority also received postoperative external radiation therapy to the mediastinum. Survival after resection was 47% at 3 years and 38% at 4 years. Survival was better when the histologic diagnosis was adenocarcinoma, when the primary tumor was small, and when the mediastinum appeared normal on regular chest roentgenograms.
Résumé Quatre-vingts malades ont été traités par exérèse du cancer du poumon et des adénopathies cancéreuses médiastinales. La résection complète de la tumeur et la dissection des ganglions médiastinaux furent pratiquées chez tous les malades. La majorité des opérés curent leur médiastin irradié après l'intervention. Le taux de survie fut de 47% à 3 ans et de 38% à 4 ans. Ce taux fut meilleur quand il s'agissait d'adénocarcinome, que la tumeur était petite et que le médiastin était normal sur les clichés thoraciques.相似文献
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Results of surgical treatment of T4 non-small cell lung cancer 总被引:11,自引:0,他引:11
Cordula C. M. Pitz Aart Brutel de la Rivire Henry A. van Swieten Cees J. J. Westermann Jan-Willem J. Lammers Jules M. M. van den Bosch 《European journal of cardio-thoracic surgery》2003,24(6):1013-1018
Objective: Because of location and invasion of surrounding structures, the role of surgical treatment for T4 tumors remains unclear. Extended resections carry a high mortality and should be restricted for selected patients. This study clarifies the selection process in non-small cell T4 tumors with invasion of the mediastinum, recurrent nerve, heart, great vessels, trachea, esophagus, vertebral body, and carina, or with malignant pleural effusion. Methods: From 1977 through 1993, 89 patients underwent resection for primary non-small cell T4 carcinomas. Resection was regarded as complete in 34 patients (38.2%) and incomplete in 55 patients (61.8%). Actuarial survival time was calculated and risk factors for late death were identified. Results: Overall hospital mortality was 19.1% (n=17). Mean 5-year survival was 23.6% for all hospital survivors, 46.2% for patients with complete resection and 10.9% for patients with incomplete resection (P=0.0009). In patients with complete resection, mean 5-year survival for patients with invasion of great vessels was 35.7%, whereas mean 5-year survival for invasion of other structures was 58.3% (P=0.05). Age, mediastinal lymph node involvement, type of operative procedure, and postoperative radiotherapy did not significantly influence survival. Conclusion: In certain T4 tumors complete resection is possible, resulting in good mean 5-year survival especially for tumors with invasion of the trachea or carina. High hospital mortality makes careful patient selection imperative. 相似文献
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Locally advanced non-small cell lung cancer (NSCLC), particularly clinical Stage IIIA NSCLC with mediastinal lymph node metastasis, is known to be quite heterogeneous, comprising approximately one-fourth of cases of NSCLC. In this subset, patients with a minor tumor load in the mediastinal lymph nodes, such as microscopically or pathologically proven N2 in the resected specimens, are treated with surgery followed by adjuvant chemotherapy. Meanwhile, the current standard of care for patients with bulky or infiltrative N2 disease is concurrent chemoradiotherapy. The potential role of surgery in multi-modality treatment for clinical N2-Stage IIIA remains controversial. Several prospective clinical trials of this subset have been conducted; however, the heterogeneity of the N2 status and differences in chemotherapy regimens and/or radiation modalities between clinical trials make the results difficult to compare. No optimal chemotherapy regimen has been established to control possible micrometastasis, and radiotherapy is often used to achieve maximum local disease control and minimize post-surgical complications. This review summarizes the findings of prospective clinical trials that assessed the role of surgery in treating clinical N2-Stage IIIA patients within the last two decades and discusses the present status of induction treatment followed by surgery for clinical N2-Stage IIIA NSCLC. 相似文献
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Sugarbaker DJ 《Thorax》2003,58(7):639-641
The choice between conservative resection or standard anatomical resection for stage I NSCLC depends on the size and biology of the tumour and the age and state of health of the patient. 相似文献
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N Martini 《The Annals of thoracic surgery》1986,42(4):357-358
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Inoue M Sawabata N Takeda S Ohta M Ohno Y Maeda H 《The Journal of thoracic and cardiovascular surgery》2004,127(4):1100-1106
OBJECTIVES: Non-small cell lung cancer with mediastinal lymph node involvement is a heterogeneous entity different from single mediastinal lymph node metastasis to multiple nodes or extranodal disease. The objective of this study was to identify the subpopulation of patients with N2 disease who can benefit from surgical intervention. METHODS: We reviewed 219 consecutive patients with N2 non-small cell lung cancer treated with a thoracotomy between November 1980 and June 2002 and retrospectively analyzed 154 of those who had p-stage IIIA disease and underwent a complete resection. Age, sex, side (right or left), histology, location (upper or middle-lower lobe), tumor size, c-N factor, and N2 level (single or multiple) were used as prognostic variables. RESULTS: The 3- and 5-year survivals were 45.3% and 28.1%, respectively, in patients with p-stage IIIA (N2) disease. Survival for those with single N2 non-small cell lung cancer was significantly better than in those with multiple N2 disease (P =.0001), and patients with a tumor in the upper lobe showed a significantly longer survival than those with middle-lower lobe involvement (P =.0467). The 3- and 5-year survivals for patients with single N2 disease with a primary tumor in the upper lobe were 74.9% and 53.5%, respectively. A multivariate analysis with Cox regression identified 5 predictors of better prognosis: younger age, squamous cell carcinoma as determined by histology, primary tumor location in the upper lobe, c-N0 status, and a single station of mediastinal node metastasis. CONCLUSION: Our results suggest that of the heterogeneity of N2 diseases, patients with single N2 disease with non-small cell lung cancer in the upper lobe are good candidates for pulmonary resection. 相似文献