Zhang Guo-Qing, Han Feng, Gao Sheng-Li, A Di-Li, Pang Zuo-Liang
Department of Thoracic Surgery, Tumor Hospital, Xinjiang Medical University, Ulumnqi, Xinjiang, 830011, PR China.
Ai Zheng. 2007 May;26(5):519-23.
BACKGROUND & OBJECTIVE: Correctly dealing with mediastinum lymph nodes during operation is critical to the prognosis of resectable non-small cell lung cancer (NSCLC) of stage IIIA, but the removal extent of mediastinum lymph nodes is controversial. This study was to explore the effects of 2 patterns of mediastinum lymph node resection on long-term survival of stage IIIA NSCLC patients.
Clinical data of 219 stage IIIA NSCLC patients, underwent complete resection from Jan. 1999 to Jan. 2004 in Xinjiang Tumor Hospital, were reviewed. Of the 219 patients, 109 underwent mediastinal lymph node sampling (LS), and 110 underwent systematic mediastinal lymphadenectomy (SML). Survival statuses of the patients were analyzed by Life table method and Kaplan-Meier method; the prognosis was analyzed with Cox multivariate regression model.
The 1-, 3-, and 5-year survival rates were 82%, 28%, 13% in LS group, and 88%, 37%, 16% in SML group. The median survival time was significantly longer in SML group than in LS group (23.5 months vs. 20.0 months, P<0.05). Cox multivariate analysis showed that histopathologic type, metastasis state of mediastinal lymph nodes, mediastinum lymph node resection pattern were prognostic factors of stage IIIA NSCLC patients.
As compared with LS, SML in radical operation could improve the survival rate of stage IIIA NSCLC patients.
手术中正确处理纵隔淋巴结对可切除的ⅢA期非小细胞肺癌（NSCLC）的预后至关重要，但纵隔淋巴结的切除范围存在争议。本研究旨在探讨两种纵隔淋巴结切除方式对ⅢA期NSCLC患者长期生存的影响。
回顾性分析1999年1月至2004年1月在新疆肿瘤医院接受根治性切除的219例ⅢA期NSCLC患者的临床资料。其中109例行纵隔淋巴结采样（LS），110例行系统性纵隔淋巴结清扫（SML）。采用寿命表法和Kaplan-Meier法分析患者的生存状况；用Cox多因素回归模型分析预后。
LS组1年、3年、5年生存率分别为82%、28%、13%，SML组分别为88%、37%、16%。SML组中位生存时间显著长于LS组（23.5个月对20.0个月，P<0.05）。Cox多因素分析显示，组织病理类型、纵隔淋巴结转移状态、纵隔淋巴结切除方式是ⅢA期NSCLC患者的预后因素。
与LS相比，根治性手术中SML可提高ⅢA期NSCLC患者的生存率。
