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目的:观察ⅢA~N_2期非小细胞肺癌(NSCLC)诱导化疗加手术患者的术后复发及生存情况,分析淋巴结降期对预后的影响,探索术后放疗的必要性。方法:回顾性选取天津医科大学肿瘤医院2009年1月至2014年6月116例接受诱导化疗加手术的ⅢA~N_2期NSCLC患者116例,全组均为R0切除。Kaplan-Meier法计算局部无复发生存期(local-recurrence free survival,LRFS)、无远处转移生存期(distant-metastasis free survival,DMFS)和生存期(overall survival,OS),Log-rank法比较组间差异,Cox模型多因素预后分析。结果:全组中位随访时间24.42个月。pN_0、pN_1、pN_2期患者分别为40例(34.5%)、16例(13.8%)和60例(51.7%),3年复发率分别为27.5%、56.2%和51.7%。77例患者接受了辅助化疗,其中pN_0、pN_1、pN_2患者3年复发率分别为26.9%、58.3%和46.2%。多因素分析中,pN_0是影响LRFS的因素。pN_1组的LRFS短于pN_0组(P=0.048),pN_1组和pN_2组的LRFS差异无统计学意义(P=0.314)。全组5年生存率为46.6%,多因素分析显示pT_1、pN_(0~1)、诱导化疗疗效是影响OS的因素。pN_2组的OS短于pN_1组和pN_0组(P<0.05),pN_1组和pN_0组的OS差异无统计学意义(P=0.412)。结论:淋巴结降期虽然是ⅢA~N_2期NSCLC诱导化疗加手术患者的良好预后因素,但是淋巴结降期的pN_0和pN_1患者,即使接受了辅助化疗,仍有较高复发风险,有必要探索诱导化疗+手术+术后放疗的新模式。
OBJECTIVE: To observe the postoperative recurrence and survival of patients with stage ⅢA-N_2 non-small cell lung cancer (NSCLC) induced chemotherapy and surgery, analyze the effect of lymph node metastasis on prognosis and explore the necessity of postoperative radiotherapy. Methods: A total of 116 patients with stage ⅢA-N_2 NSCLC who underwent induction chemotherapy and operation from January 2009 to June 2014 in Cancer Hospital of Tianjin Medical University were retrospectively selected. All patients underwent R0 resection. Kaplan-Meier method was used to calculate the local recurrence free survival (LRFS), distant metastasis free survival (DMFS) and overall survival (OS) Differences between groups and multivariate prognostic analysis of Cox model. Results: The median follow-up time was 24.42 months. The patients with pN_0, pN_1 and pN_2 were 40 (34.5%), 16 (13.8%) and 60 (51.7%) patients, respectively. The 3-year recurrence rates were 27.5%, 56.2% and 51.7%, respectively. 77 patients received adjuvant chemotherapy, of which pN_0, pN_1, pN_2 three-year recurrence rates were 26.9%, 58.3% and 46.2%. In multivariate analysis, pN_0 was a factor affecting LRFS. The LRFS of pN_1 group was shorter than that of pN_0 group (P = 0.048). There was no significant difference in LRFS between pN_1 group and pN_2 group (P = 0.314). The 5-year overall survival rate was 46.6%. Multivariate analysis showed that pT_1, pN_ (0-1) and induction chemotherapy were the factors influencing OS. The OS of pN_2 group was shorter than that of pN_1 group and pN_0 group (P <0.05). There was no significant difference in OS between pN_1 group and pN_0 group (P = 0.412). Conclusions: Although lymph node metastasis is a good prognostic factor for induction of chemotherapy and surgery in patients with stage ⅢA-N_2 NSCLC, patients with pN_0 and pN_1 with lymph node descension may have a higher risk of recurrence despite adjuvant chemotherapy and it is necessary to explore the induction chemotherapy + Surgery + new mode of postoperative radiotherapy.