153例经外科干预的非小细胞肺癌伴胸膜播散患者的预后研究

  目的  探讨经不同外科治疗方式干预的非小细胞肺癌（non-small cell lung cancer，NSCLC）伴胸膜播散患者的预后。  方法  回顾性分析2002年5月至2011年5月153例在中国医学科学院肿瘤医院胸外科接受外科手术并于术中或术后确诊NSCLC伴胸膜播散患者的临床资料。  结果  全组患者，3年和5年生存率分别为38.5%和24.2%，中位生存时间29.0个月。其中31例接受胸膜结节活检术，122例接受原发肿瘤切除术，两组患者5年生存率分别是16.1%和26.2%，中位总生存时间分别为24.0个和29.0个月，两组间生存差异均无统计学意义（P>0.05）。122例接受原发肿瘤切除术患者中，是否行淋巴结清扫和转移结节切除，以及行部分肺叶或肺叶切除对患者预后影响无显著性差异（P>0.05）。  结论  NSCLC伴胸膜播散患者预后较差，行不同外科干预方式生存未显示出显著性差异，外科干预的主要作用是除外及证实胸膜播散以明确病理诊断，指导后续治疗，肿瘤切除应慎重，其意义有待进一步探讨。 

Prognosis of 153 non-small cell lung cancer patients with pleural dissemination after surgery

Objective:To evaluate the prognosis of non-small cell lung cancer (NSCLC) patients with pleural dissemination after differ-ent surgical interventions. Methods:We retrospectively reviewed clinical and survival data of 153 NSCLC patients with pleural dissemi-nation who were diagnosed and treated in our hospital from May 2002 to May 2011. Results:The overall 3-and 5-year survival rates of all the patients are 38.5%and 24.2%, respectively, with a median survival time (MST) of 29.0 months. A total of 122 patients accept-ed primary tumor resection whereas the remaining 31 received pleural biopsy. The 5-year survival rate of the primary tumor resection group was 26.2%with a MST of 29.0 months and 16.1%for the pleural biopsy group with a MST of 24.0 months. The survival analysis showed no significant differences in the prognosis between the primary tumor resection and pleural biopsy groups (P>0.05). In the pri-mary tumor resection group, different surgical interventions (with or without lymph nodes dissection, with or without metastatic nod-ules resection, lobe, or partial lobe resection) had no effect on prognosis (P>0.05). Conclusion:Patients with pleural dissemination had poor prognosis. Different surgical interventions showed no survival benefits for patients with NSCLC regarding pleural dissemination. The role of surgery was to rule out or confirm pleural dissemination. The definite value of surgery still needs further exploration.