Martini N, Kris M G, Flehinger B J, Gralla R J, Bains M S, Burt M E, Heelan R, McCormack P M, Pisters K M, Rigas J R
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Ann Thorac Surg. 1993 Jun;55(6):1365-73; discussion 1373-4. doi: 10.1016/0003-4975(93)91072-u.
From 1984 to 1991, 136 patients with histologically confirmed non-small cell lung cancer and stage IIIa (N2) disease received two to three cycles of MVP (mitomycin + vindesine or vinblastine + high-dose cisplatin) chemotherapy. All patients had clinical N2 disease, defined as bulky mediastinal lymph node metastases or multiple levels of lymph node involvement in the ipsilateral mediastinum or subcarinal space on chest roentgenograms, computed tomographic scans, or mediastinoscopy. The overall major response rate to chemotherapy was 77% (105/136). Thirteen patients had a complete response and 92 patients had a partial but major response (> 50%). The overall complete resection rate was 65% (89/136) with a complete resection rate of 78% (82/105) in patients with a major response to chemotherapy. There was no histologic evidence of tumor in the resected specimens of 19 patients. The overall survival was 28% at 3 years and 17% at 5 years (median, 19 months). For patients who had complete resection, the median survival was 27 months and the 3-year and 5-year survivals were 41% and 26%, respectively. There were seven treatment-related deaths, five of which were postoperative deaths. To date, 33 patients, all of whom had complete resection, have had no recurrence after treatment. These results demonstrate that (1) preoperative chemotherapy with MVP produces high response rates in stage IIIa (N2) disease, (2) high complete resection rates occur after response to chemotherapy, and (3) survival is longest in patients who have a complete resection after major response to chemotherapy.
1984年至1991年期间，136例经组织学确诊为非小细胞肺癌且处于Ⅲa期（N2）的患者接受了两至三个周期的MVP（丝裂霉素+长春地辛或长春碱+大剂量顺铂）化疗。所有患者均有临床N2期疾病，定义为胸部X线片、计算机断层扫描或纵隔镜检查显示纵隔淋巴结转移灶较大，或同侧纵隔或隆突下间隙有多个层面的淋巴结受累。化疗的总体主要缓解率为77%（105/136）。13例患者完全缓解，92例患者部分缓解但为主要缓解（>50%）。总体完全切除率为65%（89/136），化疗有主要缓解的患者完全切除率为78%（82/105）。19例患者的切除标本中无肿瘤组织学证据。3年总生存率为28%，5年总生存率为17%（中位生存期为19个月）。对于完全切除的患者，中位生存期为27个月，3年和5年生存率分别为41%和26%。有7例与治疗相关的死亡，其中5例为术后死亡。迄今为止，33例均已完全切除的患者治疗后未复发。这些结果表明：（1）MVP术前化疗对Ⅲa期（N2）疾病有较高的缓解率；（2）化疗有反应后完全切除率较高；（3）化疗有主要反应后完全切除的患者生存期最长。
