Ginsberg R J, Martini N, Zaman M, Armstrong J G, Bains M S, Burt M E, McCormack P M, Rusch V W, Harrison L B
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Ann Thorac Surg. 1994 Jun;57(6):1440-5. doi: 10.1016/0003-4975(94)90098-1.
We analyzed the results of surgical treatment of all patients presenting with untreated superior sulcus tumors between 1974 to 1991 inclusive at our institution. Most patients received preoperative radiotherapy. We attempted to analyze the influence of surgical resection and intraoperative brachytherapy in obtaining locoregional control and disease-free survival. One hundred twenty-four patients underwent thoracotomy and 100 patients underwent resection. The overall 5-year survival rate was 26% for all patients and 30% for resected patients. Those patients receiving a complete resection achieved a 41% 5-year survival. The best single group were those patients undergoing a lobectomy (versus wedge resection) and en-bloc chest wall resection (60% 5-year survival). We were unable to demonstrate an advantage for the use of intraoperative brachytherapy in those patients with complete resection. For those patients with incomplete resection, the use of brachytherapy combined with preoperative or postoperative external radiation therapy resulted in a 9% 5-year survival. Locoregional failure was significant both in patients with complete resection and in patients with incomplete resection. Adverse prognostic factors included Horner's syndrome, N2 and N3 disease, T4 disease, and incomplete resections. In superior sulcus tumors, every attempt to completely resect the tumor by en-bloc chest wall resection combined with lobectomy and adequate nodal staging remains the surgical treatment of choice together with either preoperative, postoperative, or "sandwich" external radiation therapy.
我们分析了1974年至1991年（含）间在我院就诊的所有未经治疗的肺上沟瘤患者的手术治疗结果。大多数患者接受了术前放疗。我们试图分析手术切除和术中近距离放射治疗对实现局部区域控制和无病生存的影响。124例患者接受了开胸手术，100例患者接受了切除术。所有患者的总体5年生存率为26%，接受切除术患者的5年生存率为30%。那些接受完全切除的患者5年生存率为41%。最佳的单一治疗组是那些接受肺叶切除术（相对于楔形切除术）和整块胸壁切除术的患者（5年生存率为60%）。我们未能证明术中近距离放射治疗对那些完全切除的患者有优势。对于那些不完全切除的患者，近距离放射治疗联合术前或术后外照射放疗的5年生存率为9%。局部区域失败在完全切除和不完全切除的患者中均很显著。不良预后因素包括霍纳综合征、N2和N3期疾病、T4期疾病以及不完全切除。在肺上沟瘤中，通过整块胸壁切除术联合肺叶切除术及充分的淋巴结分期来彻底切除肿瘤的每一次尝试，仍然是与术前、术后或“三明治”式外照射放疗一起的首选手术治疗方法。
