术前单疗程化疗治疗ⅢA期非小细胞肺癌的临床评价

发布时间：2016-05-07 06:26

术前单疗程化疗治疗ⅢA期非小细胞肺癌的临床评价

【摘要】 目的 探讨术前单疗程化疗加外科手术治疗ⅢA期非小细胞肺癌的可行性和毒性反应，同时评价其对切除率和生存率的影响。方法：从2002年8月~2003年2月，对166例ⅢA期非小细胞肺癌进行前瞻性随机对照试验，试验组(术前化疗组)和对照组各83例，前者进行术前化疗1个疗程。其中鳞癌44例以CAP方案，腺癌39例以FAD方案治疗，化疗结束10~14天后接受手术；对照组直接行手术治疗。两组均在术后行4~6次化疗。结果：试验组化疗的有效率为56.7%（47/83），手术切除率试验组和对照组分别为92.8%（77/83）；85.5%（71/83）。术后1、2、3、5年生存率试验组和对照组分别为91.6%（76/83），79.9%（58/83），48.2%（40/83），28.9%（24/83）；84.3%（70/83），62.7%（52/83），38.6%（32/83），19.3%（16/83）。两组手术并发症和手术死亡率比较均无显著性差异，生存率比较有显著性差异。结论：术前单疗程化疗安全、有效，能提高手术切除率及术后生存率，同时并不增加并发症发生率和死亡率。
【关键词】肺肿瘤   术前化疗   随机临床试验   手术切除率   术后生存率

【Abstract】Object  To explore the 1 cycle preoperative chemotherapy in the treatment of stage ⅢA NSCLC and to evaluate its effects on tumor response, resection rate, survival rate. Methods  From Aug 2001 to Jan 2003, 166 patients were randomly divided into group A（preoperative chemotherapy group）and group B（control group, without preoperative chemotherapy）. The patients in group A were give 1 cycle preoperative chemotherapy, and operations were performed in 10 to 14 days after chemotherapy. The regimens included CAP in 44 cases (adenocarcinoma), FAD in 39 cases（squamous）. The patients in group B were firstly operated. 4~6 cycle postoperative chemotherapy were given in all patients in group A and B. Results  The tumor response to induction chemotherapy was 56.7%（47/83）in group A. The resection rate was 92.8%（77/83）in group A, and 85.5%（71/83）in group B. The 1-，2-，3-，5-year survival rate were 91.6%（76/83）、79.9%（58/83）、48.2%（40/83）、28.9%（24/83）in group A, 84.3%（70/83）、62.7%（52/83）、38.6%（32/83）、19.3%（16/83）in group B.   No significant differences of operative complications rate and mortality were observed between the group A and group B. Conclusion The results demonstrate that the 1 cycle preoperative chemotherapy was safe and effective. It was helpful to increase the resection rate and survival rate of the tumor of patients with stage ⅢA NSCLC.
【Key words】lung neoplasm  Preoperative chemotherapy  Randomized clinical trial  Resection rate   Survival rate

人类应用术前化疗加外科手术治疗非小细胞肺癌开始于20世纪80年代末期[1]。目前，国内外报道多是应用2~3个疗程的术前化疗，而术前进行单疗程化疗则鲜有报道。为了评价术前单疗程化疗的有效性、毒副反应和对手术切除率和生存率的作用，我科从2001年8月~2003年1月，对166例ⅢA期NSCLC施行术前单疗程化疗，现将结果报告如下。

资料和方法

本组病例为我院2001年8月~2003年1月收治的部分ⅢA期NSCLC患者共166名，全部病例均有术前病理学或细胞学诊断以及术后病理学诊断。采用随机抽签法分别进入试验组(术前化疗组)和对照组(单纯手术组)。两组各83例。两组患者的一般资料见表1。

结    果
讨  论

综上所述，单疗程术前化疗用于治疗 ⅢA期NSCLC，住院时间短，经济消耗低，，能够比较有效地缩小瘤体，提高手术切除率及生存率，而不增加手术并发症和死亡率，是较适合临床实际应用的辅助治疗方法。

参考文献

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