ⅢA-N2期非小细胞肺癌完全切除术后复发危险因素分析

摘要

目的 探讨ⅢA-N2期非小细胞肺癌(NSCLC)纵隔淋巴结转移特征和完全切除术后复发的危险因素.方法 回顾性分析2001年1月至2013年12月北京中日友好医院胸外科92例接受根治性切除手术并经病理确诊为ⅢA-N2期的NSCLC患者,比较术后复发组和无复发组的临床病理资料,将可能影响预后的临床病理特征纳入Cox比例风险模型进行多因素分析.结果 术后3年和5年复发率分别为61.0％和70.2％;单因素分析提示淋巴结转移总数、淋巴结总阳性率、纵隔淋巴结转移数、纵隔淋巴结阳性率、纵隔淋巴结转移数量＞3、纵隔淋巴结多站转移、跨区域转移、多区域转移是影响预后的因素,Cox多因素分析表明纵隔淋巴结跨区域转移(P =0.035)和纵隔淋巴结转移数量＞3(P =0.045)是术后复发的独立危险因素.跨区域转移者复发风险是区域内转移者的2.0倍,纵隔淋巴结转移数量＞3者的复发风险是1～3者的2.2倍.结论 结合纵隔淋巴结转移的位置和数量可判断ⅢA-N2期NSCLC术后复发风险,跨区域转移并且纵隔淋巴结转移数量＞3者是复发风险最高的亚组.%Objective To explore the patterns of mediastinal lymph node metastases and prognostic factors of recurrence in patients undergoing curative resection of stage Ⅲ A-N2 non-small cell lung cancer (NSCLC).Methods A total of 92 patients underwent curative operation and pathologically diagnosed as stage Ⅲ A-N2 NSCLC were retrospectively reviewed.The clinicopathological data were compared between the recurrence and non-recurrence groups.And the potential prognostic factors were included for multivariate analysis using Cox proportional hazard model.Results The 3 and 5-year recurrence rates were 61.0％ and 70.2％ respectively.For univariate analysis,the prognostic factors were number of metastatic lymph nodes,positive lymph node ratio,number of metastatic mediastinal lymph nodes (MLN),positive MLN ratio,number of MLN metastasis ＞ 3,multiple station metastasis,trans-regional metastasis and multi-zonal metastasis.A multivariate analysis using Cox regression identified 2 independent factors of prognosis:transregional MLN metastasis (P =0.035) and number of MLN metastasis ＞ 3 (P =0.045).The recurrence risk of patients with trans-regional MLN metastasis was 2.0 times higher than those with regional MLN metastasis while the recurrence risk of patients with number of MLN metastasis ＞ 3 was 2.2 times higher than those with number of MLN metastasis of 1-3.Conclusion Recurrence risk of stage Ⅲ A-N2 non-small cell lung cancer (NSCLC) after curative resection may be estimated by location and number of MLN metastasis.And the subgroup with trans-regional MLN metastasis and number of MLN metastasis ＞ 3 carries the highest risk of recurrence.