[I-IIIA期非小细胞肺癌淋巴结清扫范围：一项随机临床试验]

[Extent of lymphadenectomy in stage I-IIIA non-small cell lung cancer: a randomized clinical trial].

作者信息

Wu Y, Wang S, Huang Z

机构信息

Lung Cancer Research Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510630, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2001 Jan;23(1):43-5.

PMID:11783068

Abstract

OBJECTIVE

To study the role of radical systematic mediastinal lymphadenectomy for non-small cell lung cancer (NSCLC).

METHODS

All 504 operable eligible cases with NSCLC were randomly divided to a radical lymphadenectomy (RL) group and a conventional lymph node dissection group (control) treated between Aug. 1989 and Dec. 1995. For patients postoperatively eligible, thirteen parameters (operation type, pathological type and grade, tumor size, total number of dissected lymph nodes, number of metastatic lymph nodes, metastasis ratio of lymph nodes, postoperative TNM staging, adjuvant therapy, recurrence or metastasis, morbidity, survival and life quality) were evaluated. The end point of follow-up was Dec. 31, 1998. Lost follow-up rate was 1.9%. The results were analyzed with soft were SPSS7.5. The cumulative survival was calculated by the Kaplan-Meier method and compared by the log rank test. The prognostic factors were analyzed by the Cox model.

RESULTS

There were 320 cases, 160 cases in each group, who entered the study. The mean numbers of dissected lymph nodes was 9.49 in the RL group and 3.63 in the control group. For stage I NSCLC patients, the 1,3,5,9-year survival rate was 91.8%, 86.9%, 81.4%, 74.2% respectively in the RL group and 88.7%, 72.5%, 58.5%, 52.1% respectively in the control group (P < 0.014). However, no statistically significant difference in survival rates between RL and control groups of patients with stage II and IIIA NSCLC. The postoperative TNM staging, metastasis ratio of lymph nodes, extent of lymphadenectomy were the factors influencing long term survival upon multivariable analysis.

CONCLUSION

Classical lobectomy or pneumonectomy with radical systematic mediastinal lymphadenectomy is the surgical treatment of choice for NSCLC.

摘要

目的

研究根治性系统性纵隔淋巴结清扫术在非小细胞肺癌（NSCLC）治疗中的作用。

方法

1989年8月至1995年12月期间，将504例可手术的NSCLC合格病例随机分为根治性淋巴结清扫术（RL）组和传统淋巴结清扫组（对照组）。对术后符合条件的患者，评估13项参数（手术类型、病理类型和分级、肿瘤大小、清扫淋巴结总数、转移淋巴结数、淋巴结转移率、术后TNM分期、辅助治疗、复发或转移、发病率、生存率和生活质量）。随访终点为1998年12月31日。失访率为1.9%。结果采用SPSS7.5软件进行分析。采用Kaplan-Meier法计算累积生存率，并通过对数秩检验进行比较。采用Cox模型分析预后因素。

结果

每组各有160例、共320例患者进入研究。RL组平均清扫淋巴结数为9.49个，对照组为3.63个。对于Ⅰ期NSCLC患者，RL组1年、3年、5年、9年生存率分别为91.8%、86.9%、81.4%、74.2%，对照组分别为88.7%、72.5%、58.5%、52.1%（P<0.014）。然而，Ⅱ期和ⅢA期NSCLC患者的RL组和对照组生存率差异无统计学意义。多变量分析显示，术后TNM分期、淋巴结转移率、淋巴结清扫范围是影响长期生存的因素。