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目的探讨纵隔淋巴结清扫范围对Ⅰ期非小细胞肺癌预后的影响。方法回顾性分析从1994年1月至2003年12月在我院接受手术切除的330例Ⅰ期非小细胞肺癌患者的临床、病理和随访资料。根据纵隔淋巴结清扫范围将全组患者分为纵隔淋巴结清扫组(LND)和淋巴结取样组(LNS)。运用 Kaplan-Meier 生存分析和 COX 比例风险模型,对影响预后的因素进行单因素和多因素分析。结果本组患者男性233例,女性97例;中位年龄60岁。Ⅰ A 期98例,Ⅰ B 期232例。LND组140例,LNS 组190例;平均每例患者淋巴结清扫个数两组分别为(13.3±4.7)个和(5.2±3.0)个(P<0.01);平均每例患者纵隔淋巴结清扫组数两组分别为(3.7±0.9)组和(1.3±1.1)组(P<0.01)。LND 组5年和10年生存率分别为72.0%和66.1%,LNS 组为65.9%和43.0%(P<0.05)。其他影响预后的因素包括诊断时是否出现症状、肿瘤分期、是否侵犯脏层胸膜和肿瘤大小。COX 比例风险模型分析结果显示,淋巴结清扫范围和术前有无症状是影响预后的因素。结论纵隔淋巴结清扫可以提高Ⅰ期非小细胞肺癌术后的生存率。
Objective To investigate the effect of mediastinal lymph node dissection on the prognosis of stage Ⅰ non-small cell lung cancer. Methods The clinical, pathological and follow-up data of 330 patients with stage I non-small cell lung cancer who underwent surgical resection in our hospital from January 1994 to December 2003 were retrospectively analyzed. All patients were divided into mediastinal lymph node dissection group (LND) and lymph node sampling group (LNS) according to the range of mediastinal lymph node dissection. Using Kaplan-Meier survival analysis and COX proportional hazards model, univariate and multivariate analysis were performed on the factors affecting the prognosis. Results There were 233 males and 97 females in this group. The median age was 60 years. 98 cases of stage Ⅰ A, 232 cases of stage Ⅰ B. 140 cases in LND group and 190 cases in LNS group. The average number of lymph node dissection per patient in each group was (13.3 ± 4.7) and (5.2 ± 3.0) respectively (P <0.01). The average number of mediastinal lymph node dissection groups The two groups were (3.7 ± 0.9) group and (1.3 ± 1.1) group (P <0.01). The 5-year and 10-year survival rates in LND group were 72.0% and 66.1%, respectively, and those in LNS group were 65.9% and 43.0%, respectively (P <0.05). Other prognostic factors include the presence or absence of symptoms at the time of diagnosis, stage of the tumor, invasion of the visceral pleura, and tumor size. COX proportional hazards model analysis showed that lymph node dissection range and preoperative asymptomatic factors are prognostic factors. Conclusion Mediastinal lymphadenectomy can improve the postoperative survival rate of stage Ⅰ non-small cell lung cancer.