The Rationale for Adjuvant Chemotherapy in Stage I Non-small Cell Lung Cancer

The past decade has witnessed renewed interest in studies exploring the benefits of adjuvant (postoperative) chemotherapy (± radiation therapy) in patients with resected non-small cell lung cancer (NSCLC). Recently completed adjuvant trials have included a heterogeneous group of patients with resected stages I to IIIA NSCLC. With rare exception, the published results of these studies indicate adjuvant chemotherapy imparts a significant overall survival advantage. Subset analyses suggest survival benefit occurs primarily in patients with resected stage II or IIIA and is less likely to occur in stage I patients. This apparent lack of survival benefit in stage I patients was seemingly validated in a prospective trial conducted by the Cancer and Leukemia Group B in which stage IB patients were randomized to observation or adjuvant carboplatin and paclitaxel. Survival at 5 -years was identical in the two arms of this trial. By contrast, two contemporary postoperative chemotherapy trials also conducted exclusively in stage I NSCLC patients yielded positive survival results. The divergent outcome of the prospective trials along with the negative subset analyses has created uncertainty as to the utility of postoperative adjuvant chemotherapy in stage I NSCLC. Herein we review the data underlying this controversy and offer a proposed algorithm to aid the clinician in selecting patients whom we believe may benefit from adjuvant chemotherapy. The treatment algorithm is based on currently available tumor- and host-related factors that affect prognosis.     

术后放射治疗对非小细胞肺癌疗效的影响

目的：探讨术后放射治疗对非小细胞肺癌疗效的影响。方法：1989年1月至1993年12月，在本院接受手术治疗的非小细胞肺癌患者中有189例无肉眼和镜下残留。病理分期为T1-3、N1-2、M0，其中75例接受术后放射治疗(综合组)，114例单纯手术治疗(手术组)。综合组于术后22～53天开始照射患侧肺门和纵隔，剂量为46-66Gy／23～33次／5-7周(中位数56Gy)。用寿命表及Log-Rank法计算和比较两组病例的生存率与局控率。结果：两组病例的年龄、性别、病理类型、临床分期和手术方式等基本相同。综合组1、3、5年生存率分别为82．7％、40．0％、2913％；手术组分别为7613％、39．5％、28、1％，两组比较差异无显著意义(X^2=0.25，P=0.6233)。综合组1、3、5年局控率分别为95、7％、78．5％、68、5％，明显高于手术组的81．0％、58．3％、55．1％(X^2=4．4961，P=0.03691)。综合组出现胸内复发的中位时间为22、5个月(747个月)，手术组为12.0个月(4～60个月)，两组比较差异有显著意义(X^2=4.103，P=4.043)。结论：术后放射治疗能提高有肺门或纵隔淋巴结转移Ⅱ、Ⅲa期非小细胞肺癌的局控率，延长复发出现的时间，但未能改善其生存率。     

189例ⅢA期非小细胞肺癌完全切除术后辅助治疗的疗效分析

背景与目的:ⅢA期非小细胞肺癌(non-small cell lung cancer,NSCIC)完全切除术后的辅助治疗一直是临床研究的热点.本研究目的在于探讨ⅢA期NSCIC完全切除术后辅助放疗或化疗对生存时间的影响.方法:收集1995年1月至2000年1月我院收治的189例ⅢA期NSCIC完全切除术后患者的临床资料,回顾分析术后放疗、化疗对患者生存期的影响.统计分析采用SPSS10统计软件,单因素分析用Kaplan-meier法计算累计生存率,各因素比较用秩和对数检验(log-rank),多因素分析采用COX模型.结果:全组的中位生存时间鳞癌为46.39个月,腺癌为26.81个月,两者比较有统计学意义(P=0.038).其中,鳞癌单纯手术21例,中位生存42.8个月;术后放疗28例,中位生存45.5个月,两者比较无统计学意义(P=0.068).术后化疗19例中位生存52.0个月,与单纯手术比较无统计学意义(P=0.075).腺癌单纯手术41例,中位生存26.7个月;术后放疗43例,中位生存26.6个月,两者比较无统计学意义(P=0.555);术后化疗37例,中位生存37.9个月,与单纯手术比较无统计学意义(P=0.0242).多因素分析结果显示,患者的年龄、性别、治疗方式与生存期均无关;病理学类型是影响患者预后的独立因素.结论:本组资料表明病理类型是影响可完全切除ⅢA期NSCIC术后生存期的主要因素;虽然术后放疗、化疗在统计学上未能显示可延长患者生存期,但化疗有提高患者生存期的趋势.     

肺大细胞癌62例临床分析

目的：探讨肺大细胞癌的临床特点及预后因素。方法：对1954年1月～2000年12月在我院接受手术的62例肺大细胞癌患者临床资料进行分析。结果：肺大细胞癌总体1年生存率64．5％（40／62）；3年生存率30．6％（15／49）；5年生存率21．4％（9／42）；其生存率明显高于腺鳞癌和小细胞癌；较鳞癌和腺鳞癌低；影响预后的因素主要为年龄≥或〈55岁（P=0．022）、CT示纵隔淋巴结是否肿大（P=0．038）、支气管断端是否阴性（P=0．013）、淋巴结分期（P=0．045）、TNM分期（P=0．011）。结论：肺大细胞癌生存率低，影响其预后的主要因素为淋巴结转移情况、年龄及支气管断端是否阳性．     

无锁骨上淋巴结转移的局限期小细胞肺癌颈部预防照射临床分析

目的：比较颈部预防照射对无锁骨上淋巴结转移的局限期小细胞肺癌预后的影响。方法：回顾性分析1998年2 月至2005年12月间天津医科大学附属肿瘤医院有完整记录的88例局限期小细胞肺癌临床资料,分为颈部预防照射组与无颈部预防照射组。比较两组患者生存率、复发率、远转率、颈部远转率。结果：颈部预防照射组与无颈部预防照射组1 年生存率分别为：82.00% 、84.20%（P=0.785）,3 年生存率42.86% 、52.63%（P=0.675）,5 年生存率26.67% 、31.42%（P=0.641）;1 年复发率9.09% 、12.50%（P=0.663）,3 年复发率39.39% 、32.00%（P=0.562）,5 年复发率61.54% 、47.62%（P=0.341）;1 年远转率27.08% 、25.71%（P=0.889）,3 年远转率68.18% 、57.14%（P=0.312）,5 年远转率75.00% 、70.00%（P=0.642）。 预防照射组与未预防照射组分别有3 例与5例患者2 年内发生颈部淋巴结转移,均伴有其他部位的远处转移灶,该8 例患者均死于别处转移。2 年颈部淋巴结转移率分别为8.33% 与18.52% ,无显著性区别（P=0.230）,平均生存期分别为25.67、27.40个月。结论：颈部预防照射未能显著提高患者生存率、降低复发率、远转率,特别是颈部远处转率。颈部预防照射在无锁骨上淋巴结转移的局限期小细胞肺癌治疗中不是必需的放疗靶区。     

女性非小细胞肺癌患者预后影响因素分析

目的 探讨女性非小细胞肺癌预后影响因素。方法 回顾性分析326例女性非小细胞肺癌患 者的临床资料,随访生存期为2006年12月至2013年1月。采用Kaplan-Meier绘制生存曲线,Cox比例风 险回归模型进行单因素和多因素分析。结果 女性肺腺癌、肺鳞癌的5年生存率分别为28.9%和19.3% （P＜0.0001）;N2、N1、N0的5年生存率分别为4.1%、23.8%和66.1%（P＜0.0001）;治疗前有、无 胸腔积液者的5年生存率分别为6.8%和38.4%（P＜0.0001）。结论 病理类型、N分期、治疗前胸腔 积液是女性非小细胞肺癌患者的独立预后因素。     

231例非小细胞肺癌术后生存和预后分析

目的:总结Ⅱ期和Ⅲa期非小细胞肺癌根治术后的生存情况和评价影响预后的因素.方法:回顾性分析本院1999年1月～2001年3月行根治术的Ⅱ期和Ⅲa期非小细胞肺癌231例患者的临床资料.评价指标为无瘤生存期和生存期.结果:中位随访时间为2.13年,中位无瘤生存期为1.49年,仍未达到中位生存期.分期和淋巴结转移数目为有显著统计学意义的预后因素,而性别、年龄、病理类型、分化程度、根治手术范围、有无脉管瘤栓、是否行术后辅助放化疗对生存率无影响.结论:Ⅱ期和Ⅲa期非小细胞肺癌根治术后的无瘤生存期和生存期仍不理想.     

Ⅰ期非小细胞肺癌预后影响因素的研究进展

摘 要：手术是Ⅰ期非小细胞肺癌（non-small cell lung cancer,NSCLC）的首选治疗方案,然而Ⅰ期NSCLC术后的5年生存率仍不理想。诸多临床病理及分子生物学因素与Ⅰ期NSCLC的预后显著相关。辨别这些危险因素对改善Ⅰ期NSCLC的预后有着重要作用。文章就影响Ⅰ期NSCLC预后的因素进行综述。     

Prognostic Factors for Short-term Survival in Patients with Stage IV Non-small Cell Lung Cancer

Prognostic factors which can forecast short-term survival in patients with stage IV non-small cell lung cancer have not been well evaluated. Characteristics of such factors may be different from those for overall survival, and would be an important eligibility criterion for clinical trials of chemotherapy. We retrospectively analyzed the data of 158 patients with stage IV non-small cell lung cancer whose performance status was 0, 1 or 2. Univariate and multivariate logistic regression models revealed demographic variables which significantly correlated with the survival at 8 or 12 weeks. The univariate model showed the following significant variables: T factor, N factor, number of organs with metastases, grade of performance status, weight loss within 6 months, evidence of metastasis either at bone or lymph node, and lactate dehydrogenase level. The subsequent multivariate model demonstrated that both grade of performance status under 2 and number of metastasized organs less than 3 are important factors for 8- or 12-week survival. The survival rate in patients meeting the two criteria (grade of performance status under 2 and number of metastasized organs less than 3) and in those meeting only one of them was 93% versus 80% at 8 weeks (P=0.030) and 88% versus 62% at 12 weeks (P<0.001), respectively. Grade of performance status and number of organs with metastases appear to be important prognostic factors for short-term survival in patients with stage IV non-small cell lung cancer.     

HDGF在手术切除非小细胞肺癌中的异常表达及其在预测预后中的意义

背景与目的在前期研究中发现肝癌衍生生长因子(hepatoma-derived growth factor,HDGF)在A549、H226等非小细胞肺癌(non-small cell lung cancer,NSCLC)细胞中明显高表达,在促进NSCLC细胞侵袭、生长、迁移过程中起重要作用。本研究旨在进一步检测HDGF在NSCLC组织标本中的表达情况,探讨其临床意义。方法应用SP法,检测158例手术切除NSCLC及12例正常对照肺组织中HDGF蛋白表达情况,进行生存分析、预后判定。结果与12例正常对照肺组织比较,HDGF蛋白在158例NSCLC中明显高表达(P<0.001)。158例NSCLC中,HDGF高表达组(78例,占49.4%)的5年生存率为38.2%,明显低于HDGF低表达组(80例,占50.6%)的5年生存率63.1%(P=0.009)。直线相关分析表明HDGF表达水平与术后生存时间呈负相关(r=-0.183,P=0.022)。多因素生存分析表明术后病理分期和HDGF表达水平是手术切除NSCLC预后判定的独立因素。结论 HDGF在NSCLC中呈现高表达;HDGF高表达代表预后不良,HDGF可以作为手...     

Prognostic Factors for Lymph Node Negative Stage I and IIA Non-small Cell Lung Cancer: Multicenter Experiences

Background: Surgery is the only curative treatment for operable non-small lung cancer (NSCLC) and theimportance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factorsfor survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients withoutlymph node metastasis. Materials and Methods: We retrospectively analyzed 302 patients who had undergonecurative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvantchemotherapy. Results: Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinallymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stageIA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage(p<0.001) were found to be related to adjuvant chemotherapy decisions, while operation type, lypmhovascularinvasion (LVI), grade and the presence of recurrence were important factors in predicting overall survival (OS),and operation type, tumor size greater than 4 cm, T stage, LVI, and visceral pleural invasion were related withdisease free survival (DFS). Multivariate analysis showed operation type (p<0.001, hazard ratio (HR):1.91) andthe presence of recurrence (p<0.001, HR:0.007) were independent prognostic factors for OS, as well visceralpleural invasion (p=0.01, HR:0.57) and LVI (p=0.004, HR:0.57) for DFS. Conclusions: Although adjuvantchemotherapy is standard for early stage lymph node positive NSCLC, it has less clear importance in stage Iand IIA patients without lymph node metastasis.     

非小细胞肺癌318例放疗效果的临床因素分析

目的:探讨非小细胞肺癌单纯放疗的生存情况及影响预后的临床因素.方法:回顾性分析1990年1月至1997年12月收治的318例非小细胞肺癌,Ⅰ期12例,Ⅱ期71例,ⅢA期158,ⅢB期77例,均经病理或细胞学证实.采用60CO机照射,常规分割,周剂量10～12.5Gy.有49例放疗开始到半量时按治疗计划布野,全程包括原发灶及纵膈,纵膈剂量大于57Gy.其它病例纵膈剂量40Gy,生存率计算采用Kaplan-Meier法及Log-rank检验.结果:全组中位生存期10个月,1、3、5年生存率分别为43%、15%和9%.影响生存的临床因素分析结果表明,临床分期,近期疗效周剂量与预后有密切关系(P＜O.05),而放疗总剂量和纵膈剂量与预后未见明显关系(P＞0.05).结论:影响肺癌患者放疗预后的临床因素,主要是临床分期、近期疗效和周剂量的大小,而放疗总剂量和纵膈剂量高低与生存率无明显关系.