Ⅲa期非小细胞肺癌综合治疗方法的探讨

目的探讨总结Ⅲa期非小细胞肺癌患者的治疗经验。方法分析比较对188例Ⅲa期非小细胞肺癌患者,进行术前化疗+手术+术后化疗、手术+术后化疗和单纯手术治疗、单纯化疗对1、3年生存率及中位生存期(MST)的影响。术前与术后化疗方案相同(紫杉醇+卡铂或吉西他滨+卡铂),术前行2个周期,术后行4~6个周期。单纯化疗也采用上述方案4~6个周期。结果术前化疗+手术+术后化疗组的1、3年生存率均明显高于单纯手术治疗组(P<0.01),与手术+术后化疗组相比,二者1年生存率差异有统计学意义(P<0.05),而3年生存率差异无统计学意义(P>0.05)。手术+术后化疗组的1年生存率优于单纯手术治疗组,但差异无统计学意义(P=0.069)。单纯化疗组3年无生存者,MST仅为9个月,远低于术前化疗+手术+术后化疗组和手术+术后化疗组。结论对于Ⅲa期非小细胞肺癌患者,均应尽量手术治疗(完全切除或减瘤术),淋巴结清扫的效果是肯定的。术后化疗可提高生存率。新辅助化疗提高了手术的切除率,有利于改善生存期。单纯化疗效果不佳。

To Investigate the Experiences of the Multi-modality Treatment of the Patients with Stage Ⅲ Non-small Cell Lung Cancer

Objective To evaluate and summarize the experiences of the treatment of the patients with stage Ⅲ non-small cell lung cancer(NSCLC). Methods We reviewed a total of 188 cases treated with different methods, which included preoperative and postoperative chemotherapy combination with operation, operation combination with postoperative chemotherapy, simple operation and naive chemotherapy. Then the 1-year and 3-year survival rate and median survival time(MST) were analyzed and compared. The chemotherapy were all based on carboplatin combined with gemcitabin or taxol, but the preoperative received 2 or 3 cycle and postoperative received 4～6 cycle chemotherapy , and the naive chemotherapy also performed 4～6 cycle. Results The 1-year and 3-year survival rate of preoperative and postoperative chemotherapy combination with operation group exceeded the simple operation group significantly(P<0.01), but compared with postoperative chemotherapy combination with operation group the difference of 1-year survival rate was significantly(P<0.05) and that of 3-year was not evident(P>0.05). The resectability of preoperative and postoperative chemotherapy combination with operation group was better than that of postoperative chemotherapy combination with operation group(P<0.05). The 1-year survival rate of postoperative chemotherapy combination with operation group was improved compared with simple operation group but not statistically significant(P=0.069). As for naive chemotherapy group, there were no patients could live more than 3 years and the 1-year survival rate was the lowest among all groups. And its MST was only nine months less than preoperative and postoperative chemotherapy combination with operation group and postoperative chemotherapy combination with operation group evidently. Conclusion The patients with stage Ⅲ NSCLC would be received resection as possible even incomplete, and could had benefits from routine systematic hilar and mediastinal lymph node dissection. Postoperative chemotherapy might improved the survival rate. Neoadjuvant chemotherapy increased the resection rate and shown considerable improvement in survival time, but the effect of naive chemotherapy was disappointed.