ⅠB期非小细胞肺癌的预后影响因素

目的:研究影响ⅠB期非小细胞肺癌预后的因素.方法:手术治疗的67例ⅠB期非小细胞肺癌患者,均被手术病理证实为T2N0,并接受了系统淋巴结清扫术或淋巴结采样术.共392枚淋巴结被切除,201站纵隔淋巴结被清扫(上纵隔组103站,下纵隔组98站).生存分析采用Kaplan-Meier方法,采用Cox回归模型进行多因素分析.结果:67例患者中有8例死亡,2年生存率为88.4%.Cox多因素分析提示:纵隔淋巴结清扫站数≥3站者的预后优于纵隔淋巴结清扫站数＜3站者(P=0.041);原发灶≤4cm患者预后优于原发灶＞4cm患者(P=0.016),被切除的淋巴结总数、脏层胸膜受累情况、术后化疗情况、原发灶所在部位、性别及年龄等因素与患者预后没有显著的相关性.结论:增加术中纵隔淋巴结清扫站数对改善ⅠB期非小细胞肺癌的预后可能有益;原发灶＞4cm ⅠB期非小细胞肺癌患者的预后不佳,可能更适宜于接受进一步的术后治疗.     

N2肺癌预后因素分析及手术适应证的探讨

目的 :识别纵隔淋巴结转移 (N2 )的非小细胞肺癌 (non smallcelllungcancer ,NSCLC)患者根治术后的预后不利因素 ,探讨N2 肺癌合理的手术适应证。方法 :回顾1993年 1月 1日～ 2 0 0 0年 1月 3 1日 ,2 12例根治性切除及系统性淋巴结廓清术后病理诊断为N2 肺癌患者的临床资料。应用Ka plan Meier法计算生存率 ,Log rank检验比较不同临床病理因素组间患者的生存差别 ;Cox多因素回归分析 ,判定N2 肺癌预后的不利因素。结果 :本研究 5年生存率为17% ,其中有N2 临床症状、大细胞肺癌和T4患者的预后最差 ,中位生存期不足 12个月。有纵隔淋巴结转移症状 (RR =9 2 ,P <0 0 0 1)、T4肿瘤 (RR =7 15 ,P <0 0 0 1)、淋巴结被膜受侵 (RR =1 72 8,P =0 0 0 8)和多站(≥ 3站 )淋巴结转移 (RR =2 2 94,P =0 0 0 2 )是预后的不利因素。结论 :N2 非小细胞肺癌患者的预后有很大的差别 ,根治切除的适应证应该加以选择。有明显纵隔淋巴结转移症状、大细胞肺癌和T4肿瘤的N2 患者预后极差 ,不宜将外科手术作为首选的治疗方法。     

术后辅助放疗对ⅢA-N2期非小细胞肺癌的疗效探讨

目的 探讨术后辅助放疗对ⅢA-N2期非小细胞肺癌的疗效.方法 136例经病理学检查确诊为ⅢA-N2期的非小细胞肺癌患者,均行根治性手术及术后辅助化疗,辅助化疗后75例观察(A组),61例行辅助放疗(B组).结果 A组、B组1年总生存率分别为90.7%和98.4%,3年总生存率分别为41.2%和48.7%,5年总生存率分别为30.8%和33.7%(P=0.039).A组、B组1年无复发生存率分别为87.7%和95.1%,3年无复发生存率分别为59.9%和73.1%,5年无复发生存率分别为47.9%和65.8%(P=0.040).单因素生存分析提示:吸烟、临床N2期、T分期、阳性淋巴结个数、阳性淋巴结比例、N2淋巴结累及区域、辅助化疗疗程、行术后辅助放疗为预后因素.多因素生存分析提示:临床N2期、T分期、阳性淋巴结个数、行术后辅助放疗为独立预后因素.结论 ⅢA-N2期非小细胞肺癌中,术前临床诊断为N2期、T分期越晚、手术切除阳性淋巴结个数越多,预后越差;行术后放疗可提高局控率,延长总生存时间.     

淋巴结清扫数目对无淋巴结转移非小细胞肺癌患者预后的影响

  目的   探讨淋巴结清扫数目对无淋巴结转移非小细胞肺癌患者预后的影响。   方法   回顾性分析305例无淋巴结转移非小细胞肺癌患者临床病理资料。   结果   全组患者中位生存期和5年生存率分别为60.0个月和47.1%。T分期、淋巴结清扫数目和清扫站数是影响本组患者预后的独立预后因素。相同T分期患者生存率随淋巴结清扫数目增加而增高（P < 0.05）。T₁~T₂的患者中,清扫0~11枚淋巴结的患者比清扫更多数目的各组患者预后差（P <0.05）。T₃的患者中,清扫0~16枚淋巴结的患者比清扫更多数目的患者预后差（P <0.05）。淋巴结清扫数目与术后并发症发生率无显著相关性（P>0.05）。   结论   淋巴结清扫数目是无淋巴结转移非小细胞肺癌患者预后的独立预后因素。术中应清扫足够数目的淋巴结,进而提高患者生存率。      

155例肺癌患者淋巴结转移的临床研究

背景与目的胸内淋巴结(包括肺门和纵隔)转移是影响肺癌预后的重要因素之一。本研究旨在探讨原发性非小细胞肺癌胸内淋巴结转移特点及转移方式,为确定肺癌术中淋巴结清扫方式提供依据。方法按Naruke肺癌淋巴结分布图作为淋巴结清扫依据,对155例非小细胞肺癌行完全性切除及系统性淋巴结清扫术。结果155例非小细胞肺癌共清除淋巴结1553枚。总转移率为58.7%(91/155),N1占20.0%(31/155),N2占38.7%(60/155),跳跃性N2共9.7%(15/155)。肺原发肿瘤T分期与淋巴结转移之间呈线性关系。淋巴结转移率在各类型非小细胞肺癌间无差异。肺癌淋巴结可呈跳跃式纵隔转移,且区域性转移与非区域性转移均多见。结论肺癌淋巴结转移具有多组别、多区域及跳跃性特点。除临床分期为T1者外,系统性胸内淋巴结清扫在肺癌术中应常规应用。     

ⅢB期非小细胞肺癌完全切除术后生存分析

背景与目的 ⅢB期即T4／N3非小细胞肺癌多已不能手术治愈，但可完全切除的ⅢB期患者能否从手术及术后辅助治疗中获益成为人们关注的焦点。本文回顾分析我院自1997年1月1日至2001年4月30日完全切除的51例ⅢB期原发性非小细胞肺癌的肿瘤特征，以及术后辅助治疗对其生存的影响。方法 对51例完全切除术后病理证实为ⅢB期原发性非小细胞肺癌进行回顾性分析，探讨疾病的临床特征如性别、组织学类型、肿瘤分化、T分期、淋巴结状态及术后化疗、放疗对生存的影响。结果不同性别（Logrank=0．992，P=0．319）、组织学类型（Logrank=1．263，P=0．260）、分化程度（Logrank=1．104，P=0．577）、T分期（Log rank=0．106，P=0．588）、淋巴结状态（Logrank=1．297，P=0．731）及术后纵隔放疗（Logrank=0．482，P=0．488）、术后辅助化疗（Logrank=0．051，P=0．759）未能明显延长完全切除术后ⅢB期的NSCLC中位生存期及提高生存率。结论 不同的性别、病理类型、肿瘤分化、T分期、N分期对ⅢB期NSCLC完全切除术后的生存无影响，术后化疗及纵隔放疗未能改善患者的预后。     

清扫淋巴结数和N1淋巴结阳性数与Ⅱ期非小细胞肺癌预后的关系

目的 探讨淋巴结清扫相关指标与完全切除的Ⅱ期(T1～2N1)非小细胞肺癌(NSCIC)患者预后的关系.方法 回顾性分析121例完全切除的Ⅱ期NSCLC患者,分析清扫的淋巴结数、N1阳性数、N2淋巴结的总数、N1淋巴结的转移度等淋巴结的临床指标对总生存率(OS)和无病生存率(DFS)的影响.结果 单因素分析显示,清扫的淋巴结数、N1淋巴结阳性数、N1淋巴结转移度和清扫N2淋巴结的总数与OS相关;多因素分析显示,清扫的淋巴结数、N1淋巴结阳性数为影响OS的独立因素.单因素分析和多因素分析均显示,肿瘤直径、清扫淋巴结总数、N1淋巴结阳性数为DFS的独立因素.结论 对于可完全切除的Ⅱ期NSCLC患者,术中至少应清扫10枚以上淋巴结.清扫淋巴结的总数≥10枚是预后的良好因素,而N1阳性淋巴结数≥3枚是预后的不良因素.     

同侧他叶肺转移的Ⅳ期非小细胞肺癌完全切除术后的生存分析

目的:探讨肿瘤特征及术后放化疗对同侧他叶肺转移的Ⅳ期原发性非小细胞肺癌(non-small-celllungcarcinoma,NSCLC)完全切除术后生存的影响。方法:对37例完全切除术后病理确诊为同侧他叶肺转移的Ⅳ期原发性NSCLC进行回顾性研究,分析临床特征对生存的影响。结果:不同的性别(P=0·837)、组织学类型(P=0·469)、肿瘤分化(P=0·771)、T分期(P=0·997)和淋巴结状态(P=0·110)对同侧他叶肺转移的Ⅳ期NSCLC完全切除术后的预后影响差异无统计学意义。术后纵隔区放疗(P=0·082)及鳞癌的术后化疗(P=0·781)对患者预后的影响差异无统计学意义。腺癌的术后辅助化疗能明显延长中位生存期及提高生存率,P=0·047。结论:性别、病理类型、肿瘤分化、T分期、N分期不是同侧他叶肺转移的Ⅳ期NSCLC完全切除术后的预后影响因素,鳞癌术后化疗及纵隔放疗对患者的生存无影响,腺癌术后辅助化疗可明显提高生存率及延长中位生存期。     

ⅢA(N2)期非小细胞肺癌术后失败模式分析

背景与目的 术后放疗可降低局部复发率,但是否可提高IIIA(N2)期非小细胞肺癌(non-small cell lung cancer,NSCLC)生存率依然存在争议.本文将分析术后放疗的疗效、术后失败的方式及影响局部复发的因素.方法 回顾性分析IIIA(N2)NSCLC行肺切除加纵隔淋巴结清扫术,术后失败模式在局部和(或)远处,分析术后放疗对其的疗效.影响局部复发的因素及不同原发部位与术后局部复发方式的关系.结果 多因素分析显示T分期(P<0.001)、术后病理(P=0.038)、手术方式(P=0.013)及转移淋巴结组数(P=0.018)是独立的复发因素.袖状切除局部复发多出现在残端(P<0.001),而肺叶和全肺切除纵隔淋巴结复发多(P=0.025);鳞癌易发生纵隔淋巴结的复发(P=0.023),腺癌易出现远处转移(P=0.001),T分期中T1与T2-3纵隔淋巴结区的复发率分别为36.4%、62.0%(P=0.009).原发郎位不同出现的局部复发部位不同.结论 IIIA(N2)期NSCLC术后病理、T分期、手术方式是独立的复发因素.术后复发部位与手术方式、肿瘤T分期、病理类型、原发郎位有关.     

两种纵隔淋巴结清扫方式治疗的219例ⅢA期非小细胞肺癌患者生存分析

背景与目的:在可切除的ⅢA期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者手术治疗中,如何正确处理纵隔淋巴结对预后非常关键,目前国内外学者对ⅢA期NSCLC患者纵隔淋巴结的清扫范围有较大争议.本研究目的在于探讨以两种纵隔淋巴结清扫方式对NSCLC患者生存的影响.方法:回顾性分析1999年1月至2004年1月,在新疆医科大学附属肿瘤医院外科行完全性切除术的219例ⅢA期NSCLC患者的临床资料及生存状况,其中109例采用采样式纵隔淋巴结清扫术(mediastinal lymph node sampling,LS),110例采用系统纵隔淋巴结清扫术(systematic mediastinal lymphadenectomy,SML).寿命表法和Kaplan-Meier法比较累积生存率及中位生存时间,Cox多因素生存模型分析影响生存的主要因素.结果:LS组患者术后1、3、5年生存率分别为82%、28%、13%,SML组分别为88%、37%、16%,两组术后中位生存期分别为20.0、23.5个月,有统计学意义(P＜0.05).Cox多因素分析结果表明,病理类型、纵隔淋巴结转移状况、纵隔淋巴结清扫方式是影响ⅢA期NSCLC N1或N2转移患者预后的因素(P＜0.05).结论:对可手术治疗的ⅢA期NSCLC患者行系统性纵隔淋巴结清扫可以提高生存率.     

Clinicopathologic characteristics and prognostic factors in 10 783 patients with gastric cancer

Background. Although the results of gastric cancer treatment have markedly improved, this disease remains the most common cause of cancer death in Korea. Methods. Clinicopathologic characteristics were analyzed for 10 783 consecutive patients who underwent operation for gastric cancer at the Department of Surgery, Seoul National University Hospital, from 1970 to 1996. We also evaluated survival and prognostic factors for 9262 consecutive patients operated from 1981 to 1996. The clinicopathologic variables for evaluating prognostic values were classified as patient-, tumor-, and treatment-related factors. The prognostic significance of treatment modality [surgery alone, surgery + chemotherapy, surgery + immunotherapy + chemotherapy (immunochemosurgery)] was evaluated in patients with stage III gastric cancer (according to the International Union Against Cancer TNM classification of 1987). For the assessment of lymph node metastasis, both the number of involved lymph nodes and the ratio of involved to resected lymph nodes were analyzed, as a quantitative system. Results. The mean age of the 10 783 patients was 53.5 years and the male-to-female ratio was 2.07 : 1. Resection was performed in 9058 patients (84.0% resection rate). The 5-year survival rates were 55.9% for all patients and 64.8% for patients who received curative resection. Age, sex, preoperative hemoglobin and albumin levels, type of operation, curability of operation, tumor location, Borrmann type, tumor size, histologic differentiation, Lauren's classification, perineural invasion, lymphatic invasion, vascular invasion, depth of invasion, number of involved lymph nodes, ratio of involved to resected lymph nodes, and distant metastasis had prognostic significance on univariate analysis. Radical lymph node dissection, with more than 25 resected lymph nodes improved survival in patients with stage II and IIIa disease. As postoperative adjuvant therapy, immunochemotherapy was most effective in patients with stage III disease. Patients with identical numbers of lymph nodes -either the number of involved lymph nodes or the number of resected lymph nodes- were divided according to their ratios of involved-to-resected lymph nodes. In each numeric group, there were significant survival differences according to the ratio of involved-to-resected lymph nodes. However, patients who had the same involved-to-resected lymph node ratio did not show significant differences in survival rate according to either the number of involved or the number of resected lymph nodes. On multivariate analysis, curability of operation, depth of invasion, and ratio of involved to resected lymph nodes were independent significant prognostic factors. Conclusions. Curative resection, depth of invasion, and lymph node metastasis were the most significant prognostic factors in gastric cancer. With regard to the status of lymph node metastasis, the ratio of involved to resected lymph nodes had a more precise and comprehensive prognostic value than only the number of involved or resected lymph nodes. Early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy, particularly in patients with stage III gastric cancer should be the standard treatment in principle, for patients with gastric cancer. Received for publication on Apr. 13, 1998; accepted on Oct. 22, 1998     

The role of surgery and postoperative chemoradiation therapy in patients with lymph node positive esophageal carcinoma.

BACKGROUND: Patients who have undergone resection for lymph node positive esophageal carcinoma are at high risk of disease recurrence and early death. The role of postoperative adjuvant therapy in this population needs to be determined. METHODS: A retrospective review of all patients with resected esophageal carcinoma between 1991 and 1997 was performed. Lymph node positive (N1) patients who received concurrent or sequential postoperative radiotherapy (50 grays) and chemotherapy (cisplatin, 5-fluorouracil with or without epirubicin) were compared with N1 patients who underwent surgery alone. The disease free and overall survival rates were calculated using the Kaplan-Meier method, and groups were compared with the log-rank test. Prognostic variables were entered into a Cox regression model controlling for age, weight loss, T status, Eastern Cooperative Oncology Group (ECOG) score, and treatment received. RESULTS: A total of 165 patients were reviewed: Twenty-eight N1 patients underwent surgery alone (S group), and 38 N1 patients underwent surgery and received postoperative chemoradiation therapy (CRT group). Preoperative risk factors, tumor characteristics, ECOG scores, and lengths of hospital stay were similar. The disease free survival rates were similar (S group, 10.6 months; CRT group, 10.2 months), although the S group had more local disease recurrences (S group, 35%; CRT group, 13%; P = 0.09). The overall survival rate according to the Kaplan-Meier analysis showed a significant survival advantage with postoperative CRT radiation (log-rank test; P = 0.001). The median overall survival for the CRT group was 47.5 months, which was significantly longer than that of the S group (14.1 months). The ECOG score, T status, and treatment received all were found to influence survival significantly on univariate analysis. In the multivariate model, postoperative CRT was a predictor of survival (P = 0.007; risk ratio for mortality, 0.35; 95% confidence interval, 0.16-0.76) and was correlated with a significantly decreased risk of death in patients with lymph node positive, resected esophageal carcinoma. CONCLUSIONS: Postoperative CRT appears to prolong survival in patients with lymph node positive, resected esophageal carcinoma.     

胸段食管鳞癌根治术后淋巴结阳性患者不同治疗方式比较

目的 比较胸段食管鳞癌(TESCC)根治术后淋巴结阳性患者不同治疗方式的疗效,探讨其最佳治疗模式。方法 回顾性分析2007—2010年间 548例TESCC根治术后淋巴结阳性患者,分析其不同治疗方式的疗效情况,并应用倾向得分匹配(PSM)对不同治疗方式组患者进行1∶1配比,进一步分析并明确适合患者的最佳治疗模式。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox模型行多因素预后分析。结果 1、3、5年OS分别为79.9%、38.1%、28.5%,DFS分别为68.5%、39.8%、32.5%。经PSM配比后单纯手术、PORT、POCT和POCRT组患者均有可比性,1、3、5年OS和DFS差异均有统计学意义(P均=0.000)。N1、N2和N3期患者OS和DFS差异亦均有统计学意义(P均=0.000)。多因素分析显示治疗方式和N分期均为影响患者OS和DFS的影响因素(P=0.001、0.000和0.025、0.016)。结论 TESCC根治术后淋巴结阳性者预后较差且淋巴结转移数目越多则预后越差,行术后放化疗可能会提高患者生存。     

Prognostic variability among nonsmall cell lung cancer patients with pathologic N1 lymph node involvement. Epidemiological figures with strong clinical implications

BACKGROUND: Patients who have nonsmall cell lung cancer with N1 lymph node status are an intermediate group of patients who have a variable prognosis. Differences in lymph node level (hilar or pulmonary lymph nodes) may influence patient survival. The authors retrospectively analyzed the factors that influenced prognosis, including the level of N1 lymph node involvement. METHODS: The authors used the Tuscan Cancer Registry archives to retrieve records on 2523 patients who had lung tumors diagnosed during the period from 1996 and 1998 in the provinces of Florence and Prato, central Italy. To analyze the survival of patients according to the level of lymph node involvement, the prognoses of patients with nonsmall cell lung cancer who had N1 lymph node status were compared in a population-based case series. Among 112 patients with pathologic N1 status, the following variables were analyzed for their influence on postoperative survival: gender, age, cell type, pathologic tumor status, the number of metastatic lymph nodes, the level of metastatic lymph nodes (hilar or pulmonary), and the type of surgical resection. RESULTS: The 5-year survival rates for patients who had involvement of pulmonary and hilar lymph nodes were 41.2% and 21.8%, respectively (P =.005). A Cox proportional hazards model analysis indicated that the presence of hilar lymph node involvement was an independent prognostic factor. CONCLUSIONS: N1 pathologic lymph node status was identified in a combination of subgroups with different prognoses, and the presence of hilar lymph node disease had prognostic significance. This difference in survival may lead to the use of different therapies for these subgroups of patients with pathologic N1 non-small cell lung cancer.     

肺癌外科治疗210例的远期结果分析

目的 探讨影响肺癌切除术后患者远期疗效的因素。方法对1987年1月～1999年12月间210例接受肺癌切除术患者的临床、病理和随访资料进行回顾性研究。选择9个可能对预后产生影响的因素，通过COX比例风险模型进行多因素生存分析。结果全组患者3年生存率为37．4%，5年生存率为30．1％，10年生存率为23．5％。单因素分析显示：p-TNM分期中T和N的不同分期、肺癌组织学类型、手术方式和手术性质对手术后远期生存率的影响有统计学意义。多因素分析显示：p-TNM分期中T和N的不同分期和手术性质是影响预后的独立因素；N2-3期肺癌患者手术后死亡的危险比(hazard ratio)是N0-1者的2．42倍(P=0．0001)，T24期肺癌患者术后死亡危险比是T1者的3．50倍(P=0．0330)，接受姑息性手术的患者术后死亡危险比是根治性切除者的1．77倍(P=0．0224)。结论p-TNM分期中T和N的不同分期和手术性质是影响预后的最重要的三个因素，要提高肺癌患者术后远期生存率，早期手术治疗是关键，同时手术中必须彻底清扫淋巴结,避免非根治性手术。     

Survival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma. An outcomes trial

BACKGROUND: Resection of pancreatic carcinoma is resource-intensive with a limited impact on survival. Chemotherapy and/or radiotherapy (RT) have been shown to be effective palliation. To examine whether preoperative chemoradiotherapy as the initial treatment improves survival for patients with a regional pancreatic adenocarcinoma with a minimal chance of being resected successfully, an outcomes trial was conducted. METHODS: Patients with radiologically regional tumors were staged by laparotomy and/or computed tomography followed by endoscopic ultrasonography, angiography, and/or laparoscopy. Those with locally invasive, unresectable, regional pancreatic adenocarcinoma initially were treated with simultaneous split-course RT plus 5-fluorouracil, streptozotocin, and cisplatin (RT-FSP) followed by selective surgery (Group 1). Patients determined to have a resectable tumor initially underwent resection without preoperative chemoradiotherapy, with or without postoperative chemoradiotherapy (Group 2). RESULTS: Over 8 years 159 patients presenting with nonmetastatic pancreatic adenocarcinoma were administered RT-FSP or underwent surgery for resection. Group 1, comprised of 68 patients initially treated with RT-FSP, had a 0% mortality rate within 30 days of entry. In 20 of 30 patients undergoing surgery after RT-FSP, tumors were downstaged and resected. Group 2, comprised of 91 patients who initially underwent successful resection, had a 5% mortality rate within 30 days of entry. Postoperatively, 63 of these patients received chemotherapy with or without RT. The median survival for Group 1 was 23.6 months compared with 14.0 months for Group 2 (P = 0.006) despite more advanced disease cases in Group 1. Survival favored RT-FSP regardless of whether lymph nodes were malignant. The dominant prognostic factor of earlier stage pancreatic carcinoma having an expected survival advantage was reversed by the initial nonoperative treatment. CONCLUSIONS: Based on a reversal of the expected trend that patients with earlier stage resectable carcinoma (T1,2, N0,1, M0) who undergo removal of their tumors survive longer than patients with more advanced regional disease (T3, N0,1, M0), survival was found to improve significantly for patients reliably staged as having locally invasive, unresectable, nonmetastatic pancreatic adenocarcinoma when initially treated with RT-FSP.     

Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications.

PURPOSE: Patients who suffer from non-small-cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node involvement (N2) belong to a heterogeneous subgroup of patients. We analyzed the prognosis of patients with resected N2 NSCLC to propose homogeneous patient subgroups. PATIENTS AND METHODS: The present study comprised 702 consecutive patients from six French centers who underwent surgical resection of N2 NSCLC. Initially, two groups of patients were defined: patients with clinical N2 (cN2) and those with minimal N2 (mN2) disease were patients in whom N2 disease was and was not detected preoperatively at computed tomographic scan, respectively. RESULTS: The median duration of follow-up was 52 months (range, 18 to 120 months). A multivariate analysis using Cox regression identified four negative prognostic factors, namely, cN2 status (P <. 0001), involvement of multiple lymph node levels (L2+; P <.0001), pT3 to T4 stage (P <.0001), and no preoperative chemotherapy (P <. 01). For patients treated with primary surgery, 5-year survival rates were as follows: mN2, one level involved (mN2L1, n = 244): 34%; mN2, multiple level involvement (mN2L2+, n = 78): 11%; cN2L1 (n = 118): 8%; and cN2L2+ (n = 122): 3%. When only patients with mN2L1 disease were considered, the site of lymph node involvement according to the American Thoracic Society numbering system had no prognostic significance (P =.14). Preoperative chemotherapy was associated with a better prognosis for those with cN2 (P <.0001). Five-year survival rates were 18% and 5% for cN2 patients treated with and without preoperative chemotherapy, respectively. CONCLUSION: This study has identified homogeneous N2 NSCLC prognostic subgroups and suggests different therapeutic approaches according to the subgroup profile.     

Role of skip metastasis to mediastinal lymph nodes in non-small cell lung cancer

BACKGROUND: Skip metastasis to mediastinal lymph nodes is a well-known phenomenon in non-small cell lung cancer (NSCLC). Little is reported in the literature about its clinical importance. It is still under discussion whether any prognostic differences exist between resected NSCLC with either skip metastases or continuous mediastinal lymph node metastases (N2). PATIENTS AND METHODS: We analyzed retrospectively the data of 45 patients with a pN2-stage, who underwent resection for NSCLC. Seventeen of these patients (37.8%), showing no metastatic involvement of hilar (N1) lymph nodes, were compared to the remaining 28 patients with infiltration of hilar nodes (N1) as well as N2 nodes. RESULTS: Multivariate analysis showed no statistically significant difference between the skip metastasis and the continuous N2 group regarding sex, age, histology, T- or M-status. The frequency of skip metastasis was higher in patients with a primary tumor in the upper lobe (n = 12, 71%) compared to the lower lobe (n = 5, 29%). This difference was not statistically significant. In patients with a non-continuous lymph node spread, 29 out of 119 resected mediastinal lymph nodes were infiltrated (1.7 per patient, range: 1-10). Compared to 83 metastatic involved lymph nodes out of 198 resected mediastinal nodes (three per patient, range: 1-10) in patients with involvement of N1 and N2 nodes (P = 0.034, Mann-Whitney test). The 5-year survival rate of pN2 patients with skip metastasis was 41% compared to 14% in patients with involvement of N1 and N2 nodes (P = 0.019). CONCLUSIONS: pN2 patients with mediastinal lymph node skip metastasis have a more favorable prognosis compared to pN2 patients with continuous infiltration of the regional lymph nodes. Patients with a continuous lymph node involvement show an increased number of infiltrated mediastinal lymph nodes per patient compared to patients with a non-continuous spread. Skip metastasis is an independent prognostic factor of survival. The presence of skip metastasis seems to be a unique subgroup of pN2 disease in NSCLC.     

181例肺腺鳞癌患者术后预后因素分析

  目的  探讨术后Ⅰ~Ⅲ期肺腺鳞癌患者的预后及其影响因素。  方法  按照2009年国际肺癌研究协会公布的新版肺癌分期标准进行分期, 回顾性分析1994年1月至2008年12月天津医科大学附属肿瘤医院收治181例手术切除的Ⅰ~Ⅲ期肺腺鳞癌患者的临床资料, 对影响其预后的各因素进行了单因素及多因素分析。  结果  全组患者3、5年生存率分别为30.9%、19.0%, 中位生存期23.0个月。单因素分析显示淋巴结清扫方式、T分期、N分期、辅助化疗周期数是影响预后的重要因素(P < 0.05)。多因素分析结果显示淋巴结清扫方式(P=0.046)、T分期(P=0.006)、N分期(P < 0.001)、辅助化疗周期数(P=0.031)是影响预后的独立因素。  结论  肺腺鳞癌整体预后差。系统性淋巴结清扫能显著提高肺腺鳞癌患者生存时间。肿瘤的T分期越高其生存率越低, 无区域淋巴结转移组生存率较高。Ⅲ期肺腺鳞癌患者可从术后辅助化疗中获益, 应至少行4个化疗周期。