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.

Two patterns of mediastinal lymph node resection for non-small cell lung cancer of stage IIIA: survival analysis of 219 cases

BACKGROUND & OBJECTIVE: Correctly dealing with mediastinum lymph nodes during operation is critical to the prognosis of resectable non-small cell lung cancer (NSCLC) of stage IIIA, but the removal extent of mediastinum lymph nodes is controversial. This study was to explore the effects of 2 patterns of mediastinum lymph node resection on long-term survival of stage IIIA NSCLC patients. METHODS: Clinical data of 219 stage IIIA NSCLC patients, underwent complete resection from Jan. 1999 to Jan. 2004 in Xinjiang Tumor Hospital, were reviewed. Of the 219 patients, 109 underwent mediastinal lymph node sampling (LS), and 110 underwent systematic mediastinal lymphadenectomy (SML). Survival statuses of the patients were analyzed by Life table method and Kaplan-Meier method; the prognosis was analyzed with Cox multivariate regression model. RESULTS: The 1-, 3-, and 5-year survival rates were 82%, 28%, 13% in LS group, and 88%, 37%, 16% in SML group. The median survival time was significantly longer in SML group than in LS group (23.5 months vs. 20.0 months, P<0.05). Cox multivariate analysis showed that histopathologic type, metastasis state of mediastinal lymph nodes, mediastinum lymph node resection pattern were prognostic factors of stage IIIA NSCLC patients. CONCLUSION: As compared with LS, SML in radical operation could improve the survival rate of stage IIIA NSCLC patients.