术后辅助化疗对Ib期非小细胞肺癌患者无瘤生存的影响

目的:探讨术后辅助化疗对Ib期非小细胞肺癌患者无瘤生存的影响。方法:回顾性队列研究78例行肺癌根治术的Ib期非小细胞肺癌患者。采用Kaplan-Meier法研究术后辅助化疗对患者无瘤生存的影响；以肿瘤分化程度、肿瘤直径、血管侵袭、脏层胸膜侵袭危险因素将患者进行分层分析；采用Logistic回归分析Ib期患者出现复发或转移的影响因素。结果:Ib期非小细胞肺癌患者中行术后辅助化疗组无瘤生存期与观察组比较，差异有统计学意义（P=0.02）；危险因素的分层分析显示:对于肿瘤分化程度低和肿瘤直径>4 cm的Ib期非小细胞肺癌患者，术后辅助化疗组与观察组的无瘤生存期之间均有统计学差异（P<0.05）；Logistic回归分析显示影响肿瘤复发或转移的因素:肿瘤分化程度低（OR=23.983，P=0.005）、血管侵袭（OR=15.411，P=0.027）OR>1，为危险因素；术后辅助化疗（OR=0.040，P=0.007）OR<1，为保护因素。结论:对肿瘤分化程度低或肿瘤直径>4 cm的Ib期非小细胞肺癌患者建议使用术后辅助化疗，术后辅助化疗是Ib期非小细胞肺癌患者生存的保护因素，可降低肿瘤复发或转移的概率。

The effect of postoperative adjuvant chemotherapy on disease free survival in stage Ib non-small cell lung cancer patients

Objective:To investigate the effect of adjuvant chemotherapy on disease free survival in stage Ib non-small cell lung cancer patients.Methods:Retrospective cohort study of stage Ib NSCLC patients（78 cases）underwent radical resection.Kaplan-Meier method was used to analysis patients' disease free survival with postoperative adjuvant chemotherapy，stratified analysis of risk factors include the degree of tumor differentiation，the largest diameter of tumor，vascular invasion or not and visceral pleura invasion or not，Logistic regression was used to analysis factors with recurrence or metastasis in stage Ib patients.Results:Disease free survival of stage Ib NSCLC patients with postoperative adjuvant chemotherapy or observation have statistical significance（P=0.02）.Stratified analysis of risk factors indicate:There were statistical significance in stage Ib NSCLC patients with postoperative adjuvant chemotherapy or observation，whose have low degree of tumor differentiation and tumor diameter>4 cm.Logistic regression analysis indicate factors of tumor recurrence or metastasis:Low degree of tumor differentiation（OR=23.983，P=0.005），vascular invasion（OR=15.411，P=0.027），OR>1，risk factors.Postoperative adjuvant chemotherapy（OR=0.040，P=0.007），OR<1，protective factors.Conclusion:Postoperative adjuvant chemotherapy is recommended for stage Ib NSCLC patients with low degree of tumor differentiation or tumor diameter>4 cm.Postoperative adjuvant chemotherapy is a protect factor on the survival of stage Ib NSCLC patients，which can reduce the probability of tumor recurrence or metastasis.