Mathisen D J, Wain J C, Wright C, Choi N, Carey R, Hilgenberg A, Grossbard M, Lynch T, Grillo H
Section of General Thoracic Surgery, Massachusetts General Hospital, Boston 02114, USA.
J Thorac Cardiovasc Surg. 1996 Jan;111(1):123-31; discussion 131-3. doi: 10.1016/S0022-5223(96)70408-7.
Forty patients with N2 non-small-cell lung cancer (stage IIIA), as determined by mediastinoscopy, were entered into a preoperative neoadjuvant study of chemotherapy (platinum, 5-fluorouracil, vinblastine) and accelerated radiotherapy (150 cGy twice per day for 7 days) for two cycles. Surgical resection was then performed and followed up with an additional cycle of chemotherapy and radiotherapy. All patients completed preoperative therapy. A major clinical response was seen in 87% of patients. Thirty-five patients underwent resection (one preoperative death, one refused operation, one had deterioration of pulmonary function, and two had pleural metastases). Operative mortality rate was 5.7% (2/35). Sixty percent of patients had no complications. Major complications included pulmonary emboli (three), pneumonia (two), and myocardial infarction (one). Down-staging was seen in 46% of patients, with two patients (5.7%) having no evidence of tumor in the specimen, five patients having sterilization of all lymph nodes, and nine patients having sterilization of mediastinal nodes but positive N1 nodes. Median survival of 40 patients was 28 months, with a projected 5-year survival of 43%. Patients with downstaged disease had statistically significant improved survival compared with patients whose disease was not downstaged.
通过纵隔镜检查确诊为N2期非小细胞肺癌（IIIA期）的40例患者进入术前新辅助化疗（铂类、5-氟尿嘧啶、长春碱）和加速放疗（每天2次，每次150 cGy，共7天）的两个周期研究。然后进行手术切除，并接受另外一个周期的化疗和放疗。所有患者均完成术前治疗。87%的患者出现主要临床反应。35例患者接受了切除手术（1例术前死亡，1例拒绝手术，1例肺功能恶化，2例有胸膜转移）。手术死亡率为5.7%（2/35）。60%的患者无并发症。主要并发症包括肺栓塞（3例）、肺炎（2例）和心肌梗死（1例）。46%的患者出现降期，2例患者（5.7%）标本中无肿瘤证据，5例患者所有淋巴结均无肿瘤，9例患者纵隔淋巴结无肿瘤但N1淋巴结阳性。40例患者的中位生存期为28个月，预计5年生存率为43%。与未降期的患者相比，降期患者的生存率有统计学意义的提高。
