Ⅰ A期二次原发肺癌的手术疗效及预后影响因素

摘要

Objective To determine the role of surgery in the treatment of stage Ⅰ A second primary lung cancer and factors that may affect the outcomes.Methods A retrospective study was conducted to analyze 68 patients who underwent surgical resection for stage Ⅰ A second primary lung cancer in our department between January 1,2006 to December 31 2010.Results Postoperative complications occurred in 32.4％ patients,and the mortality rate was 1.5％.Lobectomy and completion pneumonectomy were associated with higher risk of postoperative complications than sublobar resection,with a complication rate of 44.4％ (16/36) and 18.8％ (6/32) respectively,P =0.037.The overall 5-year survival rate was 65.2％.There was no significant difference of 5-year survival between lobectomy/completion pneumonectomy and sublobar resection,71.1％ and 58 ％ respectively.Multivariate analysis showed that age ＞ 70 years and tumor size ＞ 2 cm were independent negative factors of long-term survival.Conclusion Surgery is safe and effective in the treatment of stage Ⅰ A second primary lung cancer,with a overall 5-year survival of 65.2％.Compared with lobectomy,sublobar resection s acceptable for the treatment of stage Ⅰ A second primary lung cancer,with equal long-term survival and lower risk of postoperative complications.Tumor size ＞ 2 cm,age ＞ 70 years are predictors of inferior survival.%目的 评价外科治疗ⅠA期二次原发肺癌的效果及影响预后的因素.方法 回顾性分析2006年1月至2010年12月于同济大学附属上海市肺科医院胸外科接受手术治疗的68例Ⅰ A期二次原发肺癌患者资料,收集临床数据,进行统计分析.男43例(63.2％),女25例(36.8％);吸烟史31例,无吸烟史37例;首次手术时年龄33～ 76岁,平均56岁.发现二次肺癌年龄为35～ 79岁,平均59.6岁;肿瘤间隔2～ 186个月,中位时间34.6个月.结果 手术并发症22例(32.4％),手术死亡1例(1.5％),肺叶/余肺切除并发症16例(44.4％,16/36),亚肺叶切除并发症6例(18.8％,6/32),P=0.037.患者总体5年生存率为65.2％.5年生存率肺叶/余肺切除患者71.1％,亚肺叶切除患者58.0％,两种术式差异无统计学意义(P =0.674).年龄＞70岁(P =0.006)、肿瘤＞2 cm(P=0.007)是影响患者预后的独立危险因素.结论 手术治疗Ⅰ A期二次原发肺癌安全、有效,术后总体5年生存率65.2％.亚肺叶切除手术并发症率低,术后生存率与肺叶切除无明显差别,可治疗Ⅰ A期二次原发肺癌.年龄＞70岁和肿瘤＞2 cm是影响患者预后的独立危险因素.