194例非小细胞肺癌患者根治术后的生存和预后分析.docVIP

194例非小细胞肺癌患者根治术后的生存和预后分析 　　作者：何丹 作者单位：新疆医科大学附属肿瘤医院胸外科， 新疆 乌鲁木齐 830011) 　　【摘要】 目的：探讨非小细胞肺癌(non-small cell lung cancer，NSCLC)根治术后影响预后的因素。方法：收集我院2001年1月～2005年1月行根治性切除的NSCLC 194例病例资料及随访资料进行回顾性分析，单因素分析各临床特征(病理分期、肿瘤大小、病理类型、分化程度、肺叶切除方式、纵隔淋巴结清扫方式、化疗周期、放疗)与生存的关系，分层分析治疗方式对患者预后的影响，并用Cox模型进行多因素分析。结果：194例患者3年生存率为62.7%，中位生存期67.8个月。单因素分析显示病理分期、分化程度、肿瘤大小、肺切除方式、纵隔淋巴结清扫方式、辅助化疗是影响预后的因素(P0.05)。多因素分析结果显示病理分期、肿瘤大小、分化程度、纵隔淋巴结清扫方式、辅助化疗是影响预后的独立因素。结论：系统性纵隔淋巴结清扫较选择性纵隔淋巴结清扫能够显著提高Ⅱ期、Ⅲ期患者3年生存率。辅助化疗能够延长患者术后生存期，化疗周期应至少行4周期。放射治疗未能显示出对根治性切除的NSCLC患者有生存优势。 　　【关键词】 肺肿瘤 非小细胞肺癌 根治术 多因素分析 预后 　　The survival and prognosis in 194 patients with non-small cell lung cancer after radical surgery 　　HE Dan， GAO Sheng-li， ZHANG Guo-qing， et al 　　(Department of Thoracic Surgery， Affliated Tumor Hospital， Xinjiang Medical University,Urumqi 830011, China) 　　Abstract： Objective： To explore the prognostic factors of non-small cell lung cancer after radical surgery. Methods： The information collected from 194 cases with NSCLC after radical surgery in January 2001 to January 2005 were analyzed retrospectively. Analized the relationship between the clinical features (pathological stage, tumor size, pathological type, differentiation, pneumonoresection, mediastinal lymph node dissection methods, cycles of chemotherapy and radiotherapy) and survial rate by singal-factor. Results： The 3-year survial rate of 194 patients was 62.7%， and the median survial time was 67.8 months. Univariate analysis showed that pathological stage， tumor size， pneumonoresection method， differentiation， mediastinal lymph node dissection methods， cycles of chemotherapy were prognostic factors. Multivariate analysis showed that pathological stage， tumor size， differentiation， mediastinal lymph node dissection methods， chemotherapy were independent prognostic factors. Conclusions： System mediastinal lymph node dissection can significantly improve the 3-year survial rate of the stage Ⅱ and stage Ⅲ NSCLC patients after radical su