非小细胞肺癌的减量性手术治疗

目的探讨非小细胞肺癌减量性手术的疗效和影响因素。方法用ＳＰＳＳ统计软件包的Ｋａｐｌａｎ－Ｍｅｉｅｒ和Ｃｏｘ模型,分析比较２４４例肺癌减量术及同期３６４例剖胸探查术的累积生存率和影响生存率因素。结果非小细胞肺癌减量术的１,３,５年累积生存率分别为５６．９％、２０．６％和１７．５％;探查术为４１．１％、７．８％和５．３％。两者比较,Ｂｒｅｓｌｏｗ＝２７．５５,Ｐ＜０．０００１。多因素分析显示,影响生存的主要因素为手术性质（减量术或探查术,Ｂ＝－０．４６００,Ｐ＜０．０００１）和有否后续治疗（Ｂ＝－０．１０５９,Ｐ＝０．０２１６）。结论肿瘤减量性手术是Ⅲ、Ⅳ期非小细胞肺癌的重要治疗手段之一,术后行放疗、化疗能有效地提高患者的生存率。

Debulking operation for non-small cell lung cancer

OBJECTIVE: To assess effectiveness and influencing factors of debulking operation for non-small cell lung cancer. METHODS: The cumulative survival and its influencing factors were analyzed and compared by the Kaplan-Meier and Cox model of SPSS for Windows in 244 patients received debulking operation and 364 received thoracotomy. RESULTS: The 1, 3, 5-year cumulative survival of patients treated with debulking operation was 56.9%, 20.6%, 17.5% respectively while that received thoracotomy was 41.1%, 7.8%, 5.3%, respectively (debulking vs thoracotomy, Breslow = 27.55, P < 0.0001). Multivariate analysis showed that the debulking operation or thoracotomy (B = -0.4600, P < 0.0001) and postoperative adjuvant therapies (B = -0.1059, P = 0.0216) were the most important influencing factors on the cumulative survival. CONCLUSION: Tumor debulking operation is an important treatment for stage III, IV non-small cell lung cancer. With postoperative adjuvant chemoradiotherapy better survival can be achieved.