TNM因素对非小细胞肺癌治疗效果的影响

目的 探讨肺部原发肿瘤的大小、淋巴结不同区域的转移及有无远处转移对非小细胞肺癌(NSCLC)综合治疗效果的影响.方法 回顾性分析手术治疗的987例NSCLC患者的临床资料,将其中以手术+化、放疗的574例患者与单纯手术治疗的413例患者进行对比分析.结果 全组患者的1、3、5、10年生存率分别为87.7%、57.5%、54.6%和54.5%.其中综合治疗组的1年生存率高于单纯手术组(P<0.01).在T4患者中,手术+放疗组的5年生存率高于单纯手术组(P<0.05).在N0患者中,手术+化疗组、手术+放疗组与单纯手术组比较,1年生存率差异有统计学意义(均P<0.05);在N1患者中,手术+化疗组、手术+放化疗组与单纯手术组比较,1年生存率差异有统计学意义(P<0.01);在N2患者中,手术+化疗组与单纯手术组比较,1年和3年生存率差异均有统计学意义(均P<0.05).结论 对于NSCLC患者,以手术为主的综合治疗疗效优于单纯手术.对T4患者应加强术后局部放疗,对NO和N1患者应辅以适度化、放疗,对N2患者则应强调辅以足够的化疗.

Impact of TNM staging and treatment mode on the prognosis of non-small cell lung cancer

Objective To study the impact of TNM staging and combined treatment mode on the survival of non-small cell lung cancer (NSCLC) patients. Methods From January 1997 to December 2002, 987 NSCLC patients were surgically treated in this hospital. Of those, 574 received combined modality therapy (surgery + chemotherapy/radiotherapy ), while 413 underwent operation alone. Their clinicopathological data were retrospectively analyzed. Results The 1-,3-, 5-, and 10-year overall survival rates were 87.7% ,57.5% ,54.6% and 54.5%, respectively, for the whole group, which were 90. 6%, 57.5%, 54.3% and 54.1% for the combined therapy group versus 83.8%, 57.6%, 55.2% and 55.2% for the group treated by surgical resection alone. The 1 -year survival rate of the combined therapy group was significantly higher than that of the surgical resection alone group (90.6% vs. 83.8% ) (P <0.01). With regard to the T factor,5-year survival rate of the combined therapy group ( surgery + radiotherapy)was higher than that of surgery alone group, especially in T4 cases (43.6% vs. 12.7% ), with a significant difference between them (P<0.05). As for the N factor, the 1-year survival rate of NO patients in the combined therapy group ( surgery + chemotherapy/radiotherapy) was significantly higher than that of surgery alone group (94.4% ,97.9% vs. 90.0% ) (P<0.05). The 1-year survival rate of N1 patients in the combined therapy group( surgery + chemotherapy or + chemotherapy and radiotherapy)was 91.7% and 100% versus 82.9% in the surgery alone group ( P < 0.01 ) ; The 1- and 3-year survival rates of N2 patients in the combined madality therapy group (surgery + chemotherapy)were 82.1% and 37.3%, while those of the surgery alone group were 69.4% and 26. 5%, respectively, with a significant difference ( P < 0. 05, P<0.01). All the severity of primary tumor, distance of lymph node involvement, and distant tumor metastasis significantly worsen the prognosis of the patients. Conclusion The prognosis in NSCLC patients treated with combined modality therapy (surgery + chemotherapy/radiotherapy) is better than that with surgery alone. The larger the original tumor and the farther the lymph node and tumor metastases, the worse the prognosis is for NSCLC patients.