[肺癌手术治疗的预后因素]

[Prognostic factors on surgical treatment for lung cancer].

作者信息

Sekine Y, Fujisawa T

机构信息

Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

出版信息

Kyobu Geka. 2003 Jul;56(8 Suppl):722-7.

PMID:12910959

Abstract

The factors for determining prognosis after lung cancer surgery are curative operation, pathological stage, pathological classification, adjuvant and neoadjuvant therapies, expression of cancer related genes, and concomitant diseases. In particular, pathological stage (especially N stage) is the most influential factor for tumor recurrence, metastasis and survival. The revision of TNM classification by The Union Internationale Contre le Cancer (UICC) in 1997 was well correlated with prognosis. The 5 year survival rates of stage Ia, Ib, IIa, IIb, and IIIa were 67, 57, 55, 39, and 23%, respectively. Neoadjuvant chemotherapy for clinical N 2 disease is expected to improve surgical curativity and survival. Tumor markers including carcinoembryonic antigen (CEA), CYFRA 21-1, and expression of cancer related genes, such as Ki 67, K-ras, bcl-2 and telomerase, are reported to reflect survival after surgery. Smoking and concomitant pulmonary diseases, such as chronic obstructive pulmonary diseases (COPD) and interstitial lung disease affect postoperative patient quality of life (QOL) and survival. We should examine these factors precisely, predict each patient's prognosis and establish an appropriate treatment strategy for each patient.

摘要

肺癌手术后决定预后的因素包括根治性手术、病理分期、病理分类、辅助和新辅助治疗、癌症相关基因的表达以及伴随疾病。特别是病理分期（尤其是N分期）是影响肿瘤复发、转移和生存的最主要因素。1997年国际抗癌联盟（UICC）对TNM分类的修订与预后密切相关。Ia期、Ib期、IIa期、IIb期和IIIa期的5年生存率分别为67%、57%、55%、39%和23%。临床N2期疾病的新辅助化疗有望提高手术治愈率和生存率。据报道，包括癌胚抗原（CEA）、细胞角蛋白19片段（CYFRA 21-1）等肿瘤标志物以及Ki 67、K-ras、bcl-2和端粒酶等癌症相关基因的表达可反映术后生存情况。吸烟以及慢性阻塞性肺疾病（COPD）和间质性肺疾病等伴随肺部疾病会影响术后患者的生活质量（QOL）和生存。我们应精确检查这些因素，预测每位患者的预后，并为每位患者制定合适的治疗策略。