Wu X W, Chen T, Yin S, Deng Y, Zhao B
Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Thoracic Surgery, The First People's Hospital of Yueyang, Yueyang 414000, China.
Zhonghua Zhong Liu Za Zhi. 2018 Oct 23;40(10):782-786. doi: 10.3760/cma.j.issn.0253-3766.2018.10.011.
To investigate the effect of mediastinal lymph node resection, metastasis status and treatment on the prognosis of patients with stage Ⅲ-pN2 non-small cell lung cancer (NSCLC). Clinical data of 206 patients who were pathologically diagnosed as stage Ⅲ-pN2 NSCLC in Tongji Hospital from July 2006 to Dec 2009 were retrospectively analyzed and followed up. Log rank test and Cox proportional hazards regression model were used to analyze the prognostic significance of mediastinal lymph node excision, metastasis state and treatment. The median overall survival (OS) time of the whole group was 29.6 months, and the median disease-free survival (DFS) time was 27.2 months. Univariate analysis showed that the less number of mediastinal lymph node stations with metastasis (single station), the less number of mediastinal lymph nodes involved (less than 2), and postoperative chemotherapy were associated with longer postoperative OS and DFS time (<0.05 for all). The patients with skip metastasis, negative metastasis of subcarinal lymph node, the lower mediastinal lymph node metastasis rate (MLNR<33%) and postoperative radiotherapy had longer OS and DFS time than those without these factors (<0.05 for all). Multivariate analysis showed that metastasis of subcarinal lymph node, MLNR and postoperative chemotherapy were the independent prognostic factors for patients with stage Ⅲ-pN2 NSCLC (<0.05 for all). Metastasis of subcarinal lymph nodes and the higher MLNR might shorten the postoperative survival time of NSCLC patients with stage Ⅲ-pN2, whereas postoperative chemotherapy prolongs the survival time.
探讨纵隔淋巴结切除、转移状态及治疗对Ⅲ期-pN2非小细胞肺癌(NSCLC)患者预后的影响。回顾性分析并随访2006年7月至2009年12月在同济医院经病理诊断为Ⅲ期-pN2 NSCLC的206例患者的临床资料。采用对数秩检验和Cox比例风险回归模型分析纵隔淋巴结切除、转移状态及治疗的预后意义。全组患者的中位总生存(OS)时间为29.6个月,中位无病生存(DFS)时间为27.2个月。单因素分析显示,纵隔淋巴结转移站数少(单站)、纵隔淋巴结受累数目少(少于2个)以及术后化疗与术后较长的OS和DFS时间相关(均P<0.05)。有跳跃转移、隆突下淋巴结转移阴性、纵隔淋巴结转移率较低(MLNR<33%)以及术后放疗的患者,其OS和DFS时间较无这些因素的患者长(均P<0.05)。多因素分析显示,隆突下淋巴结转移、MLNR及术后化疗是Ⅲ期-pN2 NSCLC患者的独立预后因素(均P<0.05)。隆突下淋巴结转移及较高的MLNR可能缩短Ⅲ期-pN2 NSCLC患者的术后生存时间,而术后化疗可延长生存时间。