影响非小细胞肺癌全肺切除术预后的因素

目的　探讨影响非小细胞肺癌患者全肺切除术预后的因素 ,为手术适应证的修正提供依据。　方法　回顾性分析行全肺切除术的 81例非小细胞肺癌患者的临床及随访资料。随访时间 5年以上。运用 χ2 检验、Kaplan Meier生存分析和COX模型多因素分析 ,对影响预后的因素进行单因素和多因素分析。　结果　本组患者肿瘤的组织学类型主要为鳞癌 (5 4 3% )、腺癌 (2 4 7% )和腺鳞癌(17 3% )。非小细胞肺癌全肺切除术后N0 、N1和N2 期患者的 5年生存率分别为 (2 0 8± 9 9) %、(15 4± 10 0 ) %和 (4 0± 2 8) % ,无围手术期死亡病例。术后合并症发生率为 2 2 2 %。单因素分析结果显示 :影响非小细胞肺癌患者全肺切除术预后的因素为年龄 ,术后合并症 ,肿瘤的组织学类型、部位和大小 ,胸壁侵犯和纵隔淋巴结转移。COX模型多因素分析结果显示 :影响患者预后的因素为术后合并症、肿瘤大小、胸壁侵犯和淋巴结转移状况。　结论　全肺切除术具有较高的术后合并症发生率。高龄、腺癌、心肺合并症和N2 期淋巴结转移是影响预后的不利因素。术前准确的肿瘤分期和心肺功能评估是病例选择的重要依据

Prognostic factor analysis of pneumonectomy for non-small cell lung cancer

OBJECTIVES: To identify predictors of survival following pneumonectomy for non-small cell lung cancer (NSCLC) and provide evidence for the revision of patient selection criteria. METHODS: 81 cases of pneumonectomy for NSCLC from January 1990 to May 1996 at our hospital were reviewed retrospectively. There were 65 men (80.2%) and 16 women (19.8%), with a mean age 53.4 +/- 9.4 years (range 20 - 68 years). Predominant histological types included squamous cell carcinoma (54.3%), adenocarcinoma (24.7%), and squamoadenocarcinoma (17.3%). After follow-up for more than 5 years, data were examined using the chi-square test, Kaplan-Meier method, and Cox-mantel test. The possible factors affecting survival were tested with univariate and multivariate analysis. RESULTS: The 5-year survival of N(0), N(1) and N(2) disease of NSCLC following pneumonectomy was (20.8 +/- 9.9)%, (15.4 +/- 10.0)% and (4.0 +/- 2.8)%, respectively. There was no perioperative death. The operative complications morbidity was 22.2%. Factors adversely affecting survival with univariate analysis included age over 60 years for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, peripheral location, tumor greatest dimension more than 10 cm, chest wall involvement and N(2) disease. Factors adversely affecting survival with multivariate analysis included cardiopulmonary complications, greatest tumor dimension more than 10 cm, chest wall involvement and N(2) disease. CONCLUSIONS: Pneumonectomy provides survival benefit with a high operative complications morbidity. Old age (>/= 60 years) for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, and N(2) disease may be negative prognostic factors of long-term survival. Patient selection should be based on cardiopulmonary evaluation and the stage of disease.