Iwasaki Akinori, Shirakusa Takayuki, Enatsu Sotarou, Maekawa Shinichi, Yoshinaga Yasuteru, Yoneda Satoshi, Hoshino Seiichiro
Second Department of Surgery, School of Medicine, Fukuoka University, 45-1, 7-chome Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
Interact Cardiovasc Thorac Surg. 2005 Apr;4(2):126-9. doi: 10.1510/icvts.2004.104380. Epub 2005 Feb 7.
In the TNM classification, patients with T2 non-small cell lung cancer (NSCLC) have heterogeneous factors. The efficacy of surgery for T2 disease remains unsatisfactory. We retrospectively reviewed 268 T2 patients with non-small cell lung cancer for whom a curative approach had been attempted between January 1994 through December 2003. All patients were subjected to lobectomy, including dissection of hilar and mediastinal lymph nodes contained in pathologically proven adenocarcinoma or squamous cell carcinoma. The overall survival rates at 5 and 7 years were 58.4% and 48.5%, respectively. Five-year survival of patients with a tumor in the left lower lobe (LLL) was 38.8%; other lobe, 61.6%. Primary tumor distribution in the LLL was significantly associated with a poor survival in T2 NSCLC. In univariate analysis, tumors size less than 4 cm, tumor in the left lower lobe, histological differentiation, lymph node involvement were significantly associated with prognosis. Multivariate analysis showed that tumor in the left lower lobe (P=0.0159), histological differentiation (P=0.0071), and lymph node involvement (P=0.0266) were found to be independent prognostic factors in cases of T2 disease. In cases where the primary tumor without well differentiation is in the LLL, surgery for T2 NSCLC should be considered carefully.
在TNM分期中，T2期非小细胞肺癌（NSCLC）患者存在多种异质性因素。T2期疾病的手术疗效仍不尽人意。我们回顾性分析了1994年1月至2003年12月期间尝试采用根治性治疗方法的268例T2期非小细胞肺癌患者。所有患者均接受肺叶切除术，包括对病理证实为腺癌或鳞癌的肺门和纵隔淋巴结进行清扫。5年和7年总生存率分别为58.4%和48.5%。左肺下叶（LLL）有肿瘤的患者5年生存率为38.8%；其他肺叶为61.6%。T2期NSCLC中，原发肿瘤位于左肺下叶与生存率低显著相关。单因素分析显示，肿瘤大小小于4 cm、位于左肺下叶、组织学分化程度、淋巴结受累与预后显著相关。多因素分析表明，左肺下叶肿瘤（P=0.0159）、组织学分化程度（P=0.0071）和淋巴结受累（P=0.0266）是T2期疾病的独立预后因素。对于原发肿瘤位于左肺下叶且分化差的病例，T2期NSCLC的手术治疗应谨慎考虑。
