The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis

Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66–5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1–8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57–1.01), (HR = 0.74, 95% CI = 0.49–1.12), and DFS (RR = 0.99, 95% CI = 0.88–1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary.     

Predictors of long-term survival in node-positive gastric carcinoma patients with curative resection

BACKGROUND AND AIMS: We analyzed the clinicopathologic features of node-positive gastric carcinoma patients who were long-term survivors (5 years or longer) and evaluated the predictive factors associated with long-term survival. PATIENTS AND METHODS: Of 554 node-positive gastric carcinoma patients with curative resection, 161 (29.1%) were long-term survivors, and 393 died of the disease before 5 years. RESULTS: The long-term survivor group had a recurrence rate of 16.1%, while the recurrence rate was 95.4% in the short-term survivor group (P < 0.05). The mean tumor size in the long-term survivors (4.5 cm) was significantly smaller than that in the short-term survivors (5.3 cm; P < 0.001). A depth of invasion greater than T3 was found more frequently in the short-term survivor group (88.1%) than in the long-term survivor group (70.1%; P < 0.001). Using Cox's proportional hazard regression model, the only factor found to be an independent, statistically significant prognostic parameter was tumor size (risk ratio, 0.301; 95% confidence interval, 0.10-0.88; P < 0.05). CONCLUSION: The tumor size emerged as the only independent, significant factor for the prediction of long-term survival in node-positive gastric carcinoma patients with curative resection.     

Performance status is a predictor of overall survival of elderly patients with muscle invasive bladder cancer

PURPOSE: Elderly patients with muscle invasive bladder cancer often present treatment challenges due to concomitant comorbidities and psychosocial factors. This study examines patterns of treatment in this population and evaluates the impact of these factors on overall survival in a contemporary population. MATERIALS AND METHODS: Common components of geriatric assessment were reviewed in 152 consecutive patients 70 years old or older presenting with nonmetastatic muscle invasive bladder cancer from January 1995 to December 2004 (median followup of 41 months). Overall survival was evaluated using Kaplan-Meier methods and a multivariate Cox model. RESULTS: Mean patient age was 76 years. Most patients underwent definitive treatment, with 114 (75%) opting for cystectomy including 29 of 114 (25%) with planned neoadjuvant chemotherapy. Only 15% were treated with palliative intent. Patients with a Karnofsky performance status of 80 or less or prior weight loss underwent bladder preservation more often than cystectomy (p <0.01). Overall survival was greatest in patients 80 years old or older compared to younger cohorts (p = 0.05) and in those treated with bladder preservation compared to other treatments (p = 0.04). In a multivariate analysis patients with a Karnofsky performance status of 80 or less had 1.8 times the risk of death compared to patients with a Karnofsky performance status of 90 or greater (95% CI 1.0-3.2, p = 0.05). CONCLUSIONS: Most elderly patients with muscle invasive bladder cancer tolerate curative therapy. However, functional status must be seriously considered. Karnofsky performance status is an important predictor of overall survival in this population, with a Karnofsky performance status of 90 or greater providing a significant survival advantage regardless of treatment type. Thus, Karnofsky performance status should be routinely incorporated into treatment planning.     

The role of surveillance in the treatment of patients with muscle‐invasive bladder cancer after chemotherapy

Study Type – Prognosis (case series)
Level of Evidence 4

OBJECTIVE

To determine the survival of patients at our institution who were clinically tumour‐free (cT0) on re‐staging transurethral resection (TUR) after treatment with chemotherapy for muscle‐invasive bladder cancer.

PATIENTS AND METHODS

In all, 55 patients with muscle‐invasive, organ‐confined transitional cell carcinoma of the bladder were treated with TUR followed by systemic chemotherapy, over a 10‐year period. Patients were separated into two groups, those who were clinically T0 and those who showed persistent disease (>cT0) on re‐biopsy after chemotherapy. Overall and disease‐specific survival rates were calculated for the two groups. The cT0 group was further followed for tumour recurrence and clinical outcomes.

RESULTS

Thirty‐one patients (56%) were clinically T0 on TUR after chemotherapy; of these patients, 22 (71%) either died from other causes (with no disease recurrence) or are alive and with no evidence of disease at a mean follow‐up of 53 months. Twenty of the 31 patients (65%) have retained their bladder with no evidence of cancer recurrence at a mean follow‐up of 46 months. Disease‐free status (cT0) at the time of TUR after chemotherapy was associated with significantly higher overall and cancer‐specific survival (hazard ratio 3.40, P = 0.003; and 8.63, P = 0.001, respectively).

CONCLUSION

Previous studies suggest that surveillance can be a reasonable option for patients with muscle‐invasive transitional cell carcinoma of the bladder who show no evidence of disease on TUR after chemotherapy. Patients with persistent bladder cancer on re‐biopsy after chemotherapy tend to fare poorly even with immediate cystectomy.     

胆囊癌综合治疗回顾性分析

目的 探讨提高胆囊癌的临床综合诊治方法.方法 回顾性分析我院2000年8月-2005年5月收治的胆囊癌住院患者的病史资料,并进行相关统计分析.结果 本组43例患者,男:女为1:2.3,中住年龄69岁.30例(69.8%)合并胆囊结石或胆管结石.30例(69.8%)CA19-9指标升高,13例(30.2%)CEA升高.35例(81.4%)术前由CT或MRI提示胆囊恶性肿瘤可能.43例患者中共30例(69.8%)行手术治疗,其中9例行根治术或扩大根治术.共14例患者接受化学治疗.本组资料共随访30例患者,5例患者仍然存活,最长存活已超过4年,其余患者生存期1～24个月,中位生存期为15个月.结论 胆囊癌的恶性程度高,预后差,术前诊断困难,缺乏敏感性和特异性均高的诊断方法,手术是治疗的主要手段.以化疗为主的胆囊癌新辅助治疗可能有助于进一步提高胆囊癌生存率,改善预后.     

放疗在胆囊癌中的研究进展

胆囊癌是一种恶性程度极高的消化道肿瘤,预后差,目前仅根治性手术切除能取得良好的治疗效果。放疗作为肿瘤辅助治疗和姑息性治疗的重要组成部分,已在多种恶性肿瘤的治疗中获得广泛应用,取得一定疗效。本文回顾既往文献,主要从胆囊癌术后放疗、术前新辅助放疗、术中放疗以及胆囊癌姑息性放疗4个方面综述放疗在胆囊癌中的研究进展。     

Review of 120 anal cancer patients

Objective  Chemoradiotherapy is the mainstay of treatment for the majority of patients with anal cancer, with abdominoperineal resection reserved for salvage. The purpose of this study was to evaluate our results after radiotherapy with or without chemotherapy, and/or surgery in terms of overall survival and colostomy free survival in patients with anal cancer.
Method  A review of patients diagnosed with anal cancer between 1991 and 2004 was performed. The principle end-points of the study were overall and colostomy-free survival.
Results  One hundred and twenty patients were identified. The T stage distribution was T1 32, T2 44, T3 19, T4 17 and TX 8. Eighteen patients had clinically involved regional nodes. Eighty patients received radiotherapy as a component of their treatment. Twenty-four of the 80 patients had a colostomy. The most common late toxicity was faecal incontinence. The overall survival and colostomy-free survival rates for all 120 patients were 58% and 79% at 5 years, respectively. For the 80 patients who received radiotherapy, the corresponding figures were 66% and 82% at 5 years, respectively.
Conclusion  Chemoradiation is effective organ preserving treatment for anal cancer. Grade 1 and 2 faecal incontinence is a relatively common late toxicity experienced by patients.     

Effect of preoperative delay on survival in patients with bladder cancer undergoing cystectomy in Quebec: a population based study

PURPOSE: In Canada there is growing concern that waiting time for cancer surgery has been increasing. We used population based data to estimate the average PD for RC in Quebec and assess whether delayed surgery has a negative impact on long-term survival. MATERIALS AND METHODS: We used the provincial billing database of the maladie du Quebec to identify all patients with bladder cancer 18 years or older who underwent RAMQ from 1990 to 2002. PD was calculated as the time elapsed between the most recent transurethral resection and the date of RC. Patients were categorized according to PD tertiles into 3 groups, namely 1) 20 or less, 2) 21 to 47 and (C) 48 days or greater. Cox proportional hazards models were used to assess the effect of PD on overall survival, while adjusting for patient and provider factors. RESULTS: During the study period 1,592 radical cystectomies were performed. Overall median PD was 33 days (95% CI 30 to 35). Median PD increased from 23 days in 1990 to 50 in 2002. After adjusting for calendar year, and patient and provider variables there were no significant differences in survival among the 3 delay categories. However, patients subject to greater than 12 weeks of delay were at 20% greater risk for dying (95% CI 1.0 to 1.5, p = 0.051). CONCLUSIONS: In line with previous reports PD greater than 12 weeks seems to be associated with a worse long-term prognosis.     

Biochemical disease-free survival in men younger than 60 years with prostate cancer treated with external beam radiation

PURPOSE: We determined the biochemical failure rate in patients 60 years and younger, and older than 60 years old who were treated with external beam radiation for localized prostate cancer or locally advanced prostate cancer. We also evaluated prognostic factors in the 2 age groups. MATERIALS AND METHODS: We reviewed the medical records of 964 patients who received full dose radiotherapy as the only treatment for prostate cancer. Followup prostate specific antigen was measured 3 to 6 months after the completion of radiotherapy and every 3 to 6 months thereafter. Biochemical failure was defined using the criteria established by the American Society for Therapeutic Radiology and Oncology Consensus Panel. Median followup in the whole study group was 48 months. RESULTS: Of the 98 men 60 years or younger 46 (47%) had biochemical failure, whereas 261 (30%) of the 866 older than 60 years old had biochemical failure. The 5 and 7-year biochemical disease-free survival rates were 55% and 47% in the younger men, and 65% and 59% in the older men, respectively. These rates were significantly lower in the younger men (p = 0.017 and 0.027, respectively). Multivariate regression showed that in men 60 years or younger initial prostate specific antigen, Gleason score and lower radiation doses were predictive of biochemical failure. CONCLUSIONS: Men with prostate cancer who are 60 years or younger and treated with radiotherapy may be at significant risk for long-term biochemical failure.     

Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced bladder cancer: a study by the Hellenic Cooperative Oncology Group

PURPOSE: Radical cystectomy represents the treatment of choice for muscle infiltrative bladder carcinoma. Adjuvant chemotherapy has been used to improve outcome after cystectomy. We report results in a prospective cohort of patients at high risk for relapse who were treated with the combination of paclitaxel and carboplatin as adjuvant treatment following cystectomy for muscle invasive bladder cancer. MATERIALS AND METHODS: A total of 92 patients with extravesical tumor extension (pT 3b or greater) or lymph node involvement (N+) were treated with 4 cycles of paclitaxel at 175 mg/m and carboplatin (area under the curve 5 according to the Calvert formula) every 3 weeks following radical cystectomy. Patients were followed every 6 months thereafter. RESULTS: Median followup was 36.6 months. Chemotherapy was well tolerated with 62% of patients receiving 100% of the expected chemotherapy doses without delays. Grade 3 or 4 neutropenia was reported in 19% of patients, while neutropenic fever was reported in 7%. Five-year overall, cause specific and disease-free survival was 28.9% (95% CI 14.8 to 43.0), 36.6% (95% CI 24.4 to 49.7) and 29% (95% CI 16.3 to 42.4), respectively. CONCLUSIONS: Adjuvant chemotherapy with paclitaxel and carboplatin is feasible and could be used as adjuvant treatment for high risk bladder carcinoma. Its true value should be assessed in prospective, randomized trials.     

Prognostic factors for long-term survival in patients with locally invasive pancreatic cancer

Background/Purpose We aimed to investigate predictors of survival in patients with resectable locally invasive pancreatic cancer. Methods The patient cohort consisted of 55 patients with locally invasive pancreatic cancer (International Union Against Cancer [UICC] stage III in 36 patients and stage IV in 19) who had undergone resection. The patients were informed about the advantages and the adverse effects of postoperative chemotherapy, and prospectively selected either observation alone or postoperative chemotherapy. The postoperative chemotherapy regimen options were: (1) intraarterial chemotherapy alone, (2) systemic chemotherapy alone, or (3) intraarterial chemotherapy combined with systemic chemotherapy. Results Overall 1-year and 2-year survival rates after resection were 40.5% and 13.5%, respectively. Median survival time was 10.9 months. Twenty-nine patients (52.7%) received postoperative chemotherapy. On univariate analysis, only postoperative chemotherapy was associated with long-term survival (P < 0.01). In the patients with postoperative chemotherapy, the 1-year survival rate and MST were 61.7% and 16.3 months, compared with 20.1% and 7.9 months in the patients without postoperative chemotherapy. Multivariate analysis also showed that only postoperative chemotherapy was identified as an independent survival factor. Conclusions It was suggested that postoperative chemotherapy was essential for the improvement of survival in patients with locally invasive pancreatic cancer.     

Stage-specific impact of pelvic lymph node dissection on survival in patients with non-metastatic bladder cancer treated with radical cystectomy

Study Type – Therapy (cohort) Level of Evidence 2b What's known on the subject? and What does the study add? In patients treated with radical cystectomy, pelvic lymph node dissection may have a beneficial effect on cancer control outcomes. We examined the effect of pelvic lymph node dissection on stage‐specific cancer control outcomes.

OBJECTIVE

• ? To examine the effect of stage‐specific pelvic lymph node dissection (PLND) on cancer‐specific (CSM) and overall mortality (OM) rates at radical cystectomy (RC) for bladder cancer.

METHODS

• ? Overall, 11 183 patients were treated with RC within the Surveillance, Epidemiology, and End Results database.
• ? Univariable and multivariable Cox regression analyses tested the effect of PLND on CSM and OM rates, after stratifying according to pathological tumour stage.

RESULTS

• ? Overall, PLND was omitted in 25% of patients, and in 50, 35, 27, 16 and 23% of patients with respectively pTa/is, pT1, pT2, pT3 and pT4 disease (P < 0.001).
• ? For the same stages, the 10‐year CSM‐free rates for patients undergoing PLND compared with those with no PLND were, respectively, 80 vs 71.9% (P = 0.02), 81.7 vs 70.0% (P < 0.001), 71.5 vs 56.1% (P = 0.001), 43.7 vs 38.8% (P = 0.006), and 35.1 vs 32.0% (P = 0.1).
• ? In multivariable analyses, PLND omission was associated with a higher CSM in patients with pTa/is, pT1 and pT2 disease (all P ≤ 0.01), but failed to achieve independent predictor status in patients with pT3 and pT4 disease (both P ≥ 0.05).
• ? Omitting PLND predisposed to a higher OM across all tumour stages (all P ≤ 0.03).

CONCLUSIONS

• ? Our results indicate that PLND was more frequently omitted in patients with organ‐confined disease.
• ? The beneficial effect of PLND on cancer control outcomes was more evident in these patients than in those with pT3 or pT4 disease.
• ? PLND at RC should always be considered, regardless of tumour stage.

     

Radical retropubic prostatectomy for prostate cancer with microscopic bladder neck involvement: survival and prognostic implications

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To report the oncological outcome of 106 patients who had locally advanced prostate cancer with microscopic bladder neck invasion, identified in a series of 1129 patients surgically treated with retropubic radical prostatectomy over a 12‐year period.

PATIENTS AND METHODS

All specimens were reviewed. Microscopic bladder neck invasion was defined as the presence of neoplastic cells within the smooth muscle bundles of the bladder neck, with no accompanying prostatic glandular tissue on the corresponding slide. Survival was analysed for different subgroups in relation to several variables.

RESULTS

The follow‐up (median 7.2 years, mean 6.68, range 0.3–14) was available for 106 patients with microscopic bladder neck invasion. Seminal vesicle invasion was present in 69.8% of the cases, lymph node involvement in 29.2%, apex infiltration in 31.8%, and positive surgical margins in 23.6%. Biochemical progression occurred in 61 (57.5%) patients, and 25 of them died from cancer. The mean (sd ) biochemical progression‐free survival was 0.68 (0.05), 0.59 (0.05), 0.40 (0.05) and 0.38 (0.05) at 1, 2, 5 and 10 years, respectively. Age, Gleason score and lymph node invasion were independent prognostic factors on multivariate analysis. Overall and cancer‐specific survival rates were 0.75 (0.04) and 0.80 (0.04) at 5 years and 0.57 (0.04) and 0.75 (0.04) at 10 years, respectively. Univariate analysis showed that seminal vesicle invasion, lymph node involvement and surgical Gleason score ≥8 significantly increased the risk of death. On multivariate analysis only the surgical Gleason score had an independent prognostic role with regard to overall survival (P = 0.01; odds ratio 2.82, 95% confidence interval 1.2–6.4) and cancer‐specific survival (P < 0.001; 8.6, 2.5–28.8).

CONCLUSIONS

In this series, overall and cancer‐specific survival rates were comparable to those reported for surgically treated cT3 prostate cancers. The lack of need for external urinary diversion during the entire follow‐up significantly contributed to the patients’ quality of life.     

Local recurrence after cystectomy and survival of patients with bladder cancer: a population based study in greater amsterdam

PURPOSE: We determined retrospectively in a population based study the survival of patients with bladder cancer and the local recurrence rate (LRR) after cystectomy. MATERIALS AND METHODS: All patients with bladder cancer diagnosed between 1988 and 2001 (vital status updated until September 2003) were selected from the Amsterdam Cancer Registry, which covers a population of 2.84 million individuals. For all patients who underwent cystectomy between 1988 and 1997 at 18 participating hospitals information on local recurrence and vital status was collected from the medical records. RESULTS: Five-year relative survival in all 8,321 bladder cancer cases combined was 75%. For clinical stage 0-a this was 99%, decreasing to 85% for stage 0-is and 82% for stage I, and to 44%, 28% and 9% for stages II to IV, respectively. Five-year relative survival after cystectomy was 81%, 44% and 23% for stages II to IV, respectively. The LRR after cystectomy was 19% in all 566 cases and all institutions combined. The LRR increased with higher pT stage and it achieved 11%, 23% and 31% for stages II to IV, respectively. It was slightly lower at oncological centers than at community hospitals (18% vs 20%, not significant). CONCLUSIONS: Survival is higher than the European average but below the value in the United States. Only 1 of 3 stages II-III cases was treated with cystectomy. Relatively high stage specific survival is experienced after cystectomy despite local recurrence in 1 of 5 patients.     

Significance of preoperative butyrylcholinesterase as an independent predictor of survival in patients with muscle-invasive bladder cancer treated with radical cystectomy

ObjectivesButyrylcholinesterase (BChE) is an alpha-glycoprotein found in the nervous system and liver. Its serum level is reduced in many clinical conditions, such as liver damage, inflammation, injury, infection, malnutrition, and malignant disease. In this study, we analyzed the potential prognostic significance of preoperative BChE levels in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC).Methods and materialsWe retrospectively evaluated 327 patients with MIBC who underwent RC from 1996 to 2013 at a single institution. Serum BChE level was routinely measured before operation in all patients. Covariates included age, gender, preoperative laboratory data (anemia, BChE, lactate dehydrogenase, and C-reactive protein), clinical T (cT) and N stage (cN), tumor grade, and RC with/without neoadjuvant chemotherapy. Univariate and multivariate analyses were performed to identify clinical factors associated with overall survival (OS) and disease-free survival (DFS). Univariate analyses were performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model.ResultsThe median BChE level was 187 U/l (normal range: 168–470 U/l). The median age of the enrolled patients was 69 years, and the median follow-up period was 51 months. The 5-year OS and DFS rates were 69.6% and 69.3%, respectively. The 5-year OS rates were 90.1% and 51.3% in the BChE≥168 and<168 U/l groups, respectively (P<0.001). The 5-year DFS rates were 83.5% and 55.4% in the BChE≥168 and≤167 U/l groups, respectively (P<0.001). In the univariate analysis, BChE, cT, cN, and RC with/without neoadjuvant chemotherapy were significantly associated with both OS and DFS. Multivariate analysis revealed that BChE was the factor most significantly associated with OS, and BChE, cT, and cN were significantly associated with DFS.ConclusionsThis study validated preoperative serum BChE levels as an independent prognostic factor for MIBC after RC.     

Use of adjuvant,preoperative chemo-radiotherapy in patients with locally advanced rectal cancer

Background: The objective of this study was to perform a non‐randomised prospective examination of the efficacy of adjuvant, preoperative chemo‐radiotherapy in patients with locally advanced rectal cancer. Methods: Between 1996 and 2001, patients presenting with biopsy‐proven, locally advanced, rectal cancers within 12 cm of the anal verge were referred for a long course of adjuvant chemo‐radiotherapy prior to their surgery. Locally advanced lesions were defined by either: (i) endoanal ultrasound showing at least full thickness penetration of the rectal wall (i.e. T3, T4); (ii) abdominal computed tomography scan showing infiltration of adjacent structures, or; (iii) clinical examination demonstrating a fixed lesion. All patients were followed through the hospital colorectal unit. A Kaplan?Meier survival analysis was used to determine survival and local recurrence rates. Results: There were 60 patients with a mean age of 61.5 years (range 33?77 years) with a sex distribution of males to females of 1.7?1.0. Curative resections were performed in 81% of these patients. The remainder (n = 12) were found to have either metastatic disease at operation (n = 5), inoperable disease (n = 2), or had positive resection margins on histology (n = 7). The mean follow up was 2.1 years (maximum 5.1 years). The overall 2‐year survival rate was 86.1% (95% CI ±5.4%). In patients undergoing curative resections, the overall 2‐year survival rate was 91.4% (95% CI ±4.8%), and the 2‐year disease free survival rate was 85.1% (95% CI ±6.2%). The 2‐year local recurrence rate was 7.5%. Conclusions: The use of adjuvant, preoperative, chemo‐radiotherapy in patients with locally advanced rectal cancer is associated with high short‐term survival and a low recurrence rate.     

新辅助化疗肺癌患者长期随访结果分析

目的 探讨新辅助化疗肺癌长期生存率及预后影响因素.方法 回顾性分析1995年6月至2007年5月256例新辅助化疗后进行外科治疗的肺癌患者的临床资料.对性别、年龄、p-TNM分期、肿瘤大小、淋巴结转移情况、病理类型、手术性质和手术方式进行单因素和多因素分析,用Kaplan-Meier法绘制生存曲线和计算生存率,Log-rank检验进行生存率显著性检验.评价可能的预后因素对长期生存的影响.结果 本组手术切除率100%,无手术死亡病例,发生术后并发症11例(4.3%).根治性手术236例(单纯肺叶切除169例,全肺切除53例,扩大切除14例),姑息性手术20例.全组1、3和5年生存率分别为79.3%、38.7%和27.0%.单因素分析显示,年龄、P-TNM分期、肿瘤大小、淋巴结转移情况和手术方式是影响新辅助化疗患者术后长期生存的因素.多因素分析显示,p-TNM分期(0R=1.323,95% CI.068～1.641,P=0.017)和年龄(OR=1.562,95% CI:1.148～2.125,P=0.005)是影响预后的独立危险因素.结论 新辅助化疗可以提高肺癌患者的长期生存率.p-TNM分期和手术方式是影响新辅助化疗患者术后长期预后的主要因素.