单病区组肺癌外科治疗的质控分析

摘要

Objective Surgical treatment of lung cancer needs to follow strict quality control standard for the aims of accuracy of pathological staging and potentially improved prognosis.However,there are short of studies related to surgical quality analysis.Methods One hundred and twelve patients were enlisted with the diagnosis of lung cancer and received surgical intervention in 2007.Surgical quality of these cases were retrospectively analyzed in compliance with three international standards,National Comprehensive Cancer Network (NCCN),American College of Surgeons’ Oncology Group (ACOSOG),and International Association for the Study of Lung Cancer (IASLC).Results No surgical death was reported in this group.According to NCCN,ACOSOG and IASLC standards,qualified operations were 82 cases (80.4％),73 cases (71.6％),45 cases (44.1％) in 102 cases with R0 resection,respectively.The median total lymph nodes,median mediastinal nodes,and N1 nodes were 27 (range 0-63),16.5 (range 0-43),and 10.5 (range 0-26),respectively.The median mediastinal node stations resected were 4 (range 0-6).In the mediastinum,stations of 4R,5,6 and 7 presented the highest frequency of receiving lymph node dissection.For N1 stations,10 and 12 were among the top list.For the whole group,1-year survival,3-year survival and 4-year survival were 92％ (95％ CI,89-95),67％ (95％ CI,62-72),57％ (95％ CI,52-62),respectively.Conclusion Quality control is the essential part of surgical treatment of lung cancer,which will facilitate the baseline standardization of clinical research.Since IASLC provides the strictest standard for lung cancer surgery,we suggest that all thoracic surgeons need to follow this standard to secure the accuracy of pathological diagnosis and for a potential better prognosis.%目的 肺癌外科治疗需要遵循严格的质量控制标准以确保手术治疗的效果和病理诊断的准确性,但目前尚未得到足够的重视.方法 回顾性总结2007年112例肺癌手术治疗的临床资料,采用美国国立综合癌症网络(NCCN,National Comprehensive Cancer Network)、美国外科学院肿瘤研究组(ACOSOG,American College of Surgeons'Oncology Group)和国际肺癌研究会(IASLC,International Association for the Study of Lung Cancer)定义的肺癌外科治疗的手术质量标准作为质控依据,分析外科质量控制工作.结果 全组患者无手术死亡.按照NCCN,AGOSOG和ISALC质控标准分析本组R0手术质量达标率分别为79.6％,70.9％和43.7％.中位淋巴结清扫数目27枚(0～ 63枚),中位纵隔淋巴结切除数目16.5枚(0～43枚),第一站淋巴结切检的中位数目是10.5枚(0～26枚).中位纵隔淋巴结清扫站数为4站(0～6站).第二站淋巴结最常清扫的部位是4R、5、6和7组淋巴结,第一站淋巴结中最常清扫的部位10和12组.全组1年生存率92％ (95％ CI,89 ～95);3年生存率67％ (95％ CI,62 ～72);4年生存率57％ (95％ CI,52 ～62).结论 质量控制工作是肺癌外科治疗的核心内容,实行符合国际标准的手术是开展高质量临床研究的前提,建议肺癌外科手术质控应遵循严格的国际标准,以期提高分期诊断的准确性.