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期非小细胞肺癌手术是否有价值
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Journal Article
期非小细胞肺癌手术是否有价值
2013
Overview
背景与目的对于Ⅲ期非小细胞肺癌（non．smallcelllungcancer,NSCLC），目前普遍倡导手术、化疗、放疗的多学科综合治疗，但许多研究者对是否应该手术提出了质疑。该研究探讨了手术对于Ⅲ期NSCLC患者的价值。方法回顾性分析2002年3月-2012年10月北京协和医院收治的经病理学确诊的Ⅲ期NSCLC患者310例。根据最初确诊时是否手术可分为手术组和非手术组。Ⅲa期根据N分期的不同可分为T4N0／T3．4N1M0期和T1-3N2M0期。采用χ2检验比较计数资料，Kaplan-Meier方法比较总生存期（overallsurvival，OS）和无进展生存期（progressionfreesurvival,PFS），并绘制生存曲线。结果ECOG评分0分和Ⅲa期NSCLC患者更倾向于手术治疗。Ⅲa期手术与非手术组的中位Os分别为38．9个月和21．8个月，中位PFS分别为19．2个月和11．9个月。两组0s的差异有统计学意义（P=0．041），PFS的差异无统计学意义（P=0．209）。Ⅲa期中的T4N0／T3-4N1M0期手术与非手术组的中位OS分别为48．7个月和20．1个月，中位PFS分别为14．6个月和10．5个月，两组OS和PFS的差异均无统计学意义（P〉0．05）；T1-3N2M0期手术与非手术组中位OS分别为38．9和30．8月，中位PFS分别为19．8个月和12．7个月，两组OS和PFS的差异亦无统计学意义（P〉0．05）。肿瘤最大径和辅助化疗对Ⅲa-N2期患者的OS和PFS的影响有统计学意义，而肿瘤的病理类型仅影响患者的OS（P〈0．05）。结论ECOG评分0分和Ⅲa期NSCLC患者更适于手术治疗。手术可延长Ⅲa期尤其是T4N0／T3．4NIM0期NSCLC患者的OS，但对PFS无改善作用。肿瘤最大径和辅助化疗对Ⅲa-N2期患者的OS和PFS均有明显影响，而肿瘤的病理类型只影响其OS。
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