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目的研究新辅助化疗诱导ⅢA期非小细胞肺癌(NSCLC)组织病理学反应对患者预后的影响。方法 40例患者完成2个周期新辅助化疗后,19例(47．5％)获客观缓解,其中完全缓解2例(5％),部分缓解17例(42．5％)。40 例ⅢA期NSCLC患者接受2个周期的新辅助化疗后手术,化疗方案由丝裂霉素、长春地辛和顺铂组成。手术后检查切除肿瘤标本的组织病理学反应。肿瘤组织对化疗的反应根据肿瘤坏死程度和残留肿瘤组织范围分为Ⅳ级、Ⅲ级、Ⅱ级和Ⅰ级。评价患者生存期与肿瘤组织对化疗反应等级之间的关系。结果40例患者的肿瘤切除标本中．2例(5％)属Ⅳ级,16例(40％)为Ⅲ级,18例(45％)为Ⅱ级,4例为Ⅰ级。肿瘤组织反应为Ⅲ -Ⅳ级患者的手术完全性切除率明显高于Ⅰ-Ⅱ级患者(P<0．05),中位生存期亦显著长于Ⅰ-Ⅱ级患者(P<0．05)。肿瘤组织反应属Ⅲ-Ⅳ级患者的3年生存率与Ⅰ-Ⅱ级患者比较明显为长(P<0．05)。结论由新辅助化疗诱导的肿瘤组织反应程度是ⅢA期NSCLC患者获成功治疗的关键因素。化疗后肿瘤切除标本上,有明显肿瘤组织反应(Ⅲ-Ⅳ级反应)存在提示患者预后较好。
Objective To investigate the effect of neoadjuvant chemotherapy on the prognosis of stage Ⅲ A non-small cell lung cancer (NSCLC) histopathology. Methods Twenty - four patients (47.5%) achieved objective remission after completing two cycles of neoadjuvant chemotherapy. Two patients (5%) were completely relieved and 17 patients (42.5%) partially relieved. Forty patients with stage Ⅲ A NSCLC underwent two cycles of neoadjuvant chemotherapy followed by mitomycin, vindesine and cisplatin. Histopathological examination of resected tumor specimens after surgery. The response of tumor tissue to chemotherapy was divided into grade IV, grade III, grade II and grade I according to the extent of tumor necrosis and residual tumor tissue. Evaluate the relationship between patient survival and tumor tissue response to chemotherapy. Results 40 cases of tumor resection specimens. Two cases (5%) were grade IV, 16 (40%) were grade III, 18 (45%) were grade II and 4 were grade I. The complete resection rate of patients with stage Ⅲ-Ⅳ tumors was significantly higher than that of stage Ⅰ-Ⅱ patients (P <0.05), and the median survival time was significantly longer than that of stage Ⅰ-Ⅱ patients (P0.05) . The 3-year survival rates of patients with stage Ⅲ-Ⅳ tumor reaction were significantly longer than those of stage Ⅰ-Ⅱ patients (P <0.05). Conclusion The degree of tumor tissue response induced by neoadjuvant chemotherapy is the key factor for the successful treatment of stage Ⅲ A NSCLC patients. Tumor resection specimens after chemotherapy, there is a clear tumor tissue reaction (Ⅲ-Ⅳ grade response) the presence of prompt patients with better prognosis.