新辅助化疗对ⅢA-N2期非小细胞肺癌淋巴结比率、预后及生存分析影响的临床研究

[Clinical study on the effects of neoadjuvant chemotherapy on lymph node ratio, prognosis, and survival analysis of stage ⅢA-N2 non-small cell lung cancer].

作者信息

Wei Y L, Cui Y H, Dong Y H, Shi W J

机构信息

Department of Cardiothoracic Surgery,the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China.

Department of Geriatrics, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2021 Jan 26;101(4):259-264. doi: 10.3760/cma.j.cn112137-20200523-01630.

DOI:10.3760/cma.j.cn112137-20200523-01630

PMID:33486934

Abstract

To investigate the effect of neoadjuvant chemotherapy (NCT) on the lymph node ratio (LNR) of patients with stage ⅢA-N2 non-small cell lung cancer (NSCLC), and analyze the relationship between LNR and prognosis. The data of 128 patients with stage ⅢA-N2 NSCLC admitted to the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Hebei North University from January 2013 to December 2018 were retrospectively collected. The patients were divided into two groups according to the treatment method. The patients in the observation group (64 cases) were treated with NCT and surgery, and the patients in the control group (64 cases) were treated with surgery. Lymph node metastasis and survival were observed in the two groups. Subgroups were divided according to LNR and N2 lymph node status, and survival analysis was performed for each subgroup. Univariate and multivariate analysis were conducted for the observation group. The number of metastatic lymph nodes, the proportion of patients with positive lymph nodes, and the rate of lymph node metastasis in the observation group were lower than those in the control group,3.8±2.1 vs 4.9±2.4,92.2% vs 100%,19.1% vs 22.4% respectively (all <0.05). Progression-free survival (PFS) and overall survival (OS) in the observation group were better than those in the control group (both <0.05). Both the observation and control subgroups with low LNR had better PFS and OS than the subgroups with high LNR (both <0.05). Patients in the observation group with non-multi-site N2 lymph node metastasis had better PFS and OS (both <0.05). Univariate analysis of observation group showed that patients with low LNR had better 2-year PFS and OS(both <0.05). Multivariate analysis showed that the higher the LNR, the greater the risk of death (=2.178,95% 1.025-4.626,=0.043) and progression (=2.130,95% 1.123-4.038,=0.021). NTC could improve the prognosis and reduce LNR of patients with stage ⅢA-N2 NSCLC, and LNR was expected to be a prognostic indicator.

摘要

探讨新辅助化疗（NCT）对ⅢA-N2期非小细胞肺癌（NSCLC）患者淋巴结比率（LNR）的影响，并分析LNR与预后的关系。回顾性收集2013年1月至2018年12月在河北北方学院附属第一医院胸心外科住院的128例ⅢA-N2期NSCLC患者的数据。根据治疗方法将患者分为两组。观察组（64例）采用NCT联合手术治疗，对照组（64例）采用单纯手术治疗。观察两组患者的淋巴结转移情况及生存情况。根据LNR和N2淋巴结状态进行亚组划分，并对各亚组进行生存分析。对观察组进行单因素和多因素分析。观察组转移淋巴结数、淋巴结阳性患者比例及淋巴结转移率均低于对照组，分别为3.8±2.1 vs 4.9±2.4、92.2% vs 100%、19.1% vs 22.4%（均P<0.05）。观察组的无进展生存期（PFS）和总生存期（OS）均优于对照组（均P<0.05）。LNR低的观察组和对照组亚组的PFS和OS均优于LNR高的亚组（均P<0.05）。观察组中N2淋巴结无多部位转移的患者PFS和OS较好（均P<0.05）。观察组单因素分析显示，LNR低的患者2年PFS和OS较好（均P<0.05）。多因素分析显示，LNR越高，死亡风险（=2.178，95% 1.025-4.626，=0.043）和进展风险（=2.130，95% 1.123-4.038，=0.021）越大。NTC可改善ⅢA-N2期NSCLC患者的预后并降低LNR，LNR有望成为一项预后指标。