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。 

Analysis of the Prognostic Factors in Resection of 181 Patients with Adenosquamous Lung Carcinoma

  Objective  To analyze the prognostic factors in the resection of stageⅠto stageⅢadenosquamous lung carcinoma.  Methods  From January 1994 to December 2008, 181 surgically treated patients with adenosquamous lung carcinoma were retrospectively investigated based on the 2009 International Association for the Study of Lung Cancer(IASLC)tumor-lymph node-metastasis classification.The correlation between clinicopathologic characteristics and prognosis was evaluated using univariate and multivariate analyses.  Results  The overall 3-and 5-year survival rates were 30.9%and 19.0%, respectively, and the median survival time was 23.0 months.By univariate analysis, lymph node resection approach, tumor(T)stage, lymph node stage, and the number of chemotherapy cycles were significantly related to patient survival(P < 0.05).By multivariate analysis, lymph node resection approach(P=0.046).T stage(P=0.006), N stage(P < 0.001), and the number of chemotherapy cycles(P=0.031)were independent prognostic factors.  Conclusion  The overall survival rate of adenosquamous lung carcinoma was low.Radical systematic mediastinal lymphadenectomy is the surgical treatment of choice for adenosquamous lung carcinoma.The survival rates at stages T1 to T4 gradually decreased.The patients without lymph node involvement(NO)had longer survival periods than those with N1 and N2 lymph node involvement.Chemotherapy significant improves the survival of patients with stageⅢdisease.Chemotherapy cycle should consist of at least 4 cycles.