2004 年日本肺癌注册研究中 IIIA-cN2/pN2 期非小细胞肺癌患者的手术治疗结果。

Surgical outcome of stage IIIA- cN2/pN2 non-small-cell lung cancer patients in Japanese lung cancer registry study in 2004.

机构信息

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

出版信息

J Thorac Oncol. 2012 May;7(5):850-5. doi: 10.1097/JTO.0b013e31824c945b.

DOI:10.1097/JTO.0b013e31824c945b

PMID:22481238

Abstract

BACKGROUND

The role of surgery in the treatment of non-small-cell lung cancer (NSCLC) with clinically manifested mediastinal node metastasis is controversial even in resectable cases because it is often accompanied by systemic micrometastasis. However, surgery is occasionally indicated for cases with single-station N2 disease or within multimodal treatment regimens, and in clinical trials. The aim of this study is to evaluate surgical outcomes in a modern cohort of patients with clinical (c-) stage IIIA-N2 NSCLC whose nodal metastasis was confirmed by pathology (cN2/pN2).

METHODS

From the central database of lung cancer patients undergoing surgery in 2004, which was founded by the Japanese Joint Committee for Lung Cancer Registration, data of patients having all conditions of NSCLC, c-stage IIIA, cN2, and pN2 were extracted, and the clinicopathologic profile of patients and surgical outcomes were evaluated.

RESULTS

Among 11,663 registered NSCLC cases, 436 patients (3.8%) (332 men and 104 women) had been extracted. Their mean age was 65 years, and histologic types included adenocarcinoma (n = 246), squamous cell carcinoma (n = 132), and others (n = 58). The proportion of R0 resection was 82.5% and the proportion of the hospital deaths among the cause of death was 2.3%. The 5-year survival rate was 30.1% for the selected group of patients. The postoperative prognosis was significantly better than those of corresponding populations extracted from the 1994 (p = 0.0001) and 1999 databases (p = 0.0411). Men and women experienced a significantly different survival outcome (p = 0.025) with 5-year survivals of 27.5% and 37.8%, respectively. Single-station N2 cases occupied 60.9 % of the cohort and showed a significantly better prognosis than multistation N2 (p = 0.0053, 35.8 % versus 22.0 % survival rate at 5 years).

CONCLUSIONS

The surgical outcomes of c-stage IIIA-cN2/pN2 NSCLC patients in 2004 were favorable in comparison with those ever reported.

摘要

背景

即使在可切除的情况下，手术在治疗临床表现为纵隔淋巴结转移的非小细胞肺癌（NSCLC）中的作用也存在争议，因为它通常伴有全身微转移。然而，对于单站 N2 疾病或多模式治疗方案中的病例，以及临床试验中，手术偶尔是指征。本研究的目的是评估 2004 年接受手术治疗的 NSCLC 患者中一组临床（c）期 IIIA-N2 患者的手术结果，这些患者的淋巴结转移通过病理学证实（cN2/pN2）。

方法

从由日本肺癌注册联合委员会设立的 2004 年肺癌患者中央数据库中，提取所有 NSCLC、c 期 IIIA、cN2 和 pN2 条件的患者数据，并评估患者的临床病理特征和手术结果。

结果

在登记的 11663 例 NSCLC 病例中，提取了 436 例患者（3.8%）（332 名男性和 104 名女性）。他们的平均年龄为 65 岁，组织学类型包括腺癌（n=246）、鳞状细胞癌（n=132）和其他（n=58）。R0 切除率为 82.5%，死亡原因中的医院死亡率为 2.3%。选定患者组的 5 年生存率为 30.1%。与从 1994 年（p=0.0001）和 1999 年数据库（p=0.0411）中提取的相应人群相比，术后预后明显更好。男性和女性的生存结果有显著差异（p=0.025），5 年生存率分别为 27.5%和 37.8%。单站 N2 病例占队列的 60.9%，预后明显优于多站 N2（p=0.0053，5 年生存率分别为 35.8%和 22.0%）。