王大权, 庞青松, 章文成, 赵路军, 徐利明, 陈曦, 陈秀丽, 刘宁波, 王平. 淋巴结降期对ⅢA～N2 期非小细胞肺癌患者术后远期疗效的影响[J]. 中国肿瘤临床, 2016, 43(2): 81-85. DOI: 10.3969/j.issn.1000-8179.2016.02.855
引用本文: 王大权, 庞青松, 章文成, 赵路军, 徐利明, 陈曦, 陈秀丽, 刘宁波, 王平. 淋巴结降期对ⅢA～N2 期非小细胞肺癌患者术后远期疗效的影响[J]. 中国肿瘤临床, 2016, 43(2): 81-85. DOI: 10.3969/j.issn.1000-8179.2016.02.855
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Daquan WANG, Qingsong PANG, Wencheng ZHANG, Lujun ZHAO, Liming XU, Xi CHEN, Xiuli CHEN, Ningbo LIU, Ping WANG. The effect of nodal downstage on long- term outcome for patients of non- small- cell lung cancer with ⅢA-N 2 stage[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(2): 81-85. DOI: 10.3969/j.issn.1000-8179.2016.02.855
Citation: Daquan WANG, Qingsong PANG, Wencheng ZHANG, Lujun ZHAO, Liming XU, Xi CHEN, Xiuli CHEN, Ningbo LIU, Ping WANG. The effect of nodal downstage on long- term outcome for patients of non- small- cell lung cancer with ⅢA-N 2 stage[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2016, 43(2): 81-85. DOI: 10.3969/j.issn.1000-8179.2016.02.855
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淋巴结降期对ⅢA～N2 期非小细胞肺癌患者术后远期疗效的影响

The effect of nodal downstage on long- term outcome for patients of non- small- cell lung cancer with ⅢA-N 2 stage

    摘要
  • 摘要: 目的：观察ⅢA ～N 2 期非小细胞肺癌（NSCLC ）诱导化疗加手术患者的术后复发及生存情况，分析淋巴结降期对预后的影响，探索术后放疗的必要性。方法：回顾性选取天津医科大学肿瘤医院2009年1 月至2014年6 月116 例接受诱导化疗加手术的ⅢA ～N 2 期NSCLC 患者116 例，全组均为R 0 切除。Kaplan-Meier 法计算局部无复发生存期（local-recurrencefreesurvival ，LRFS）、无远处转移生存期（distant-metastasisfreesurvival，DMFS）和生存期（overallsurvival，OS），Log-rank 法比较组间差异，Cox 模型多因素预后分析。结果：全组中位随访时间24.42个月。pN0、pN1、pN2 期患者分别为40例（34.5%）、16例（13.8%）和60例（51.7%），3 年复发率分别为27.5% 、56.2% 和51.7% 。77例患者接受了辅助化疗，其中pN0、pN1、pN2 患者3 年复发率分别为26.9% 、58.3% 和46.2% 。多因素分析中，pN0 是影响LRFS的因素。pN1 组的LRFS短于pN0 组（P = 0.048），pN1 组和pN2 组的LRFS差异无统计学意义（P = 0.314）。 全组5 年生存率为46.6% ，多因素分析显示pT1、pN0～1、诱导化疗疗效是影响OS的因素。pN2 组的OS短于pN1 组和pN0组（P < 0.05），pN1 组和pN0 组的OS差异无统计学意义（P = 0.412）。 结论：淋巴结降期虽然是ⅢA ～N 2 期NSCLC 诱导化疗加手术患者的良好预后因素，但是淋巴结降期的pN0 和pN1 患者，即使接受了辅助化疗，仍有较高复发风险，有必要探索诱导化疗+手术+术后放疗的新模式。

     

    Abstract: Objective:To observe the locoregional recurrence and survival of stage ⅢA-N2 non-small cell lung cancer (NSCLC) after in-duction chemotherapy and surgery, to analyze the prognosis influenced by nodal downstaging, and to explore the necessity for postop-erative radiotherapy. Methods:A total of 116 cases of stage ⅢA-N2 NSCLC were treated with induction chemotherapy and surgery be -tween January 2009and June 2014. These cases underwent R0 resection. Kaplan-Meier method was employed to calculate the local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS) of the patients. Log rank test was con -ducted to compare the differences between groups. Cox models were used to perform multivariate analysis. Results:The median fol-low- up of the patients was 24. 42months. The numbers of patients with pN0, pN1, and pN2 were40(34. 5% ), 16(13. 8% ), and 60 (51. 7%), respectively. The3-year local recurrence rates of patients with pN0, pN1, and pN2 were27. 5%, 56. 2%, and 51. 7%, respectively. In the group treated with adjuvant chemotherapy, the 3- year local- recurrence rates of patients with pN 0, pN1, and pN2 were26. 9% ,58. 3% , and 46. 2% , respectively. Multivariate analysis revealed that the significant predictor of LRFS was pN 0 during the surgery. The LRFS of patients with pN0 was greater than that of the patients with pN1 (P=0. 048 ). The LRFS of patients with pN 1 was not significantly associated with that of patients with pN2 (P=0. 314 ). The 5-year OS rate of the groups was 46. 6%. The multivariate analysis also demon strated that pT1, pN0- 1, and induction chemotherapy effects were associated with OS. The patients with pN2 yielded a poorer OS than those with pN 0 and pN 1 (P<0. 05). The patients with pN0 did not significantly differ from those with pN1 in terms of OS ( P=0. 412 ). Conclu -sion: Although the occurrence of pathologic downstaging is a well-known positive prognostic indicator after stageⅢ-N 2 NSCLC is sub-jected to chemotherapy, the local-recurrence rate of nodal-downstaged patients remains high, even when they receive adjuvant che -motherapy. Therefore, new postoperative strategies after induction chemotherapy and surgery should be developed.

     

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