Inoue Masayoshi, Okumura Meinoshin, Minami Masato, Shiono Hiroyuki, Sawabata Noriyoshi, Utsumi Tomoki, Ohno Yuko, Sawa Yoshiki
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Osaka University Graduate School of Medicine, E1-2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
Gen Thorac Cardiovasc Surg. 2007 Aug;55(8):315-21. doi: 10.1007/s11748-007-0140-8.
Preoperative therapy is an optional strategy for locally advanced lung cancer, although the indication for pulmonary resection is often marginal, when considering the survival benefit and perioperative risks. The aim of the present study was to identify prognostic predictors by assessing clinical factors including pre-thoracotomy co-morbidity.
This was a retrospective analysis of 54 patients who underwent complete resection after preoperative therapy was performed.
The overall 5-year survival rate was 38%. In patients without cardiopulmonary co-morbidity the 5-year survival rate was 49%, whereas it was 0% for those who had associated cardiopulmonary co-morbidity (P = 0.004). When analyzing only those who died from lung cancer, the group without cardiopulmonary comorbidity showed a tendency for longer survival than those in the co-morbidity group (P = 0.092). The 5-year survival rate for patients--evaluated with a Charlson Co-morbidity Index (CCI)--with a CCI score of 0, was 45%, which tended to be better than that for those with a CCI score of 1-2 (P = 0.066). Furthermore, patients with a normal prethoracotomy level of carcinoembryonic antigen (CEA) had a 5-year survival rate of 44%, which was better than the 22% for patients with elevated CEA (P = 0.013). The 5-year survival rate for patients without lymph node metastasis was 52%, whereas it was 14% for those with residual node involvement (P = 0.002). Lymph node metastasis and cardiopulmonary co-morbidity were shown to be independent poor prognostic predictors by multivariate analysis.
In addition to nodal status, preoperative cardiopulmonary co-morbidity should be noted when considering the operative indications following preoperative therapy for lung cancer patients.
术前治疗是局部晚期肺癌的一种可选策略，不过在考虑生存获益和围手术期风险时，肺切除的指征往往并不明确。本研究的目的是通过评估包括开胸术前合并症在内的临床因素来确定预后预测指标。
这是一项对54例接受术前治疗后行根治性切除术患者的回顾性分析。
总体5年生存率为38%。无心肺合并症患者的5年生存率为49%，而合并心肺合并症患者的5年生存率为0%（P = 0.004）。仅分析死于肺癌的患者时，无心肺合并症组的生存时间有长于合并症组的趋势（P = 0.092）。采用Charlson合并症指数（CCI）评估，CCI评分为0的患者5年生存率为45%，有优于CCI评分为1 - 2患者的趋势（P = 0.066）。此外，开胸术前癌胚抗原（CEA）水平正常的患者5年生存率为44%，优于CEA升高患者的22%（P = 0.013）。无淋巴结转移患者的5年生存率为52%，而有残留淋巴结受累患者的5年生存率为14%（P = 0.002）。多因素分析显示，淋巴结转移和心肺合并症是独立的不良预后预测指标。
对于肺癌患者术前治疗后的手术指征，除了淋巴结状态外，还应注意术前心肺合并症情况。
