ⅢA-N2期非小细胞肺癌手术治疗和放射治疗的疗效对比及相关预后因素的分析

发布时间：2018-09-19 16:25

【摘要】：目的:比较临床分期为IIIA-N2期非小细胞肺癌手术治疗及放射治疗的疗效,并对其影响预后的因素进行分析。方法:收集2010年1月至2011年12月于河北医科大学第四医院首诊的临床分期为IIIA-N2期非小细胞肺癌患者共177例,手术组(S组)64例,放疗组(R组)113例。其中男性144例,女性33例,中位年龄64岁,中位随访时间19个月(0.5-57.5个月)。采用Kaplan-Meier方法统计总生存率(Overall survival rates,OS)、局部控制率(Local control rates,LC)、无远处转移生存率(Free from distant metastasis survival rates,FDM)和无病生存率(Disease-free survival rates,DFS),Logrank进行单因素分析,Cox回归模型进行多因素分析,P0.05定义为统计学有显著差异。结果:1全组患者1、2、3年总生存率分别为70.4%、38.9%、26.1%,1、2、3年局部控制率分别为73.6%、54.6%、47.8%,1、2、3年无远处转移生存率分别为66.3%、48.1%、40.2%,1、2、3年无病生存率分别为49.4%、27.7%、20.5%。多因素分析显示性别、ECOG评分和辅助化疗是影响全组患者总生存率的独立预后因素。2手术组和放疗组的中位生存期和1、2、3年总生存率分别为21个月、70.2%、38.3%、30.1%和19个月、70.5%、39.3%、23.8%,两组之间无统计学差异(P=0.411)。手术组和放疗组的1、2、3年局部控制率(P=0.840)、无远处转移生存率(P=0.622)及无病生存率(P=0.913)之间也均无统计学差异。3手术组患者的预后因素分析:单因素分析结果显示ECOG评分为0分、术后辅助治疗、辅助化疗和辅助放疗者的生存较好;N2淋巴结数目≤3、单站N2淋巴结转移和辅助放疗者有较高的局部控制率。多因素分析结果显示ECOG评分和辅助放疗是影响总生存率的独立预后因素;N2阳性淋巴结数目和辅助放疗是影响局部控制率的独立预后因素。4放疗组患者的预后因素分析:①总生存率的单因素分析:男性和女性患者的1、2、3年总生存率分别为68.8%、34.4%、20.1%和78.9%、63.2%、41.4%,P=0.033。ECOG评分为0、1和2分患者的1、2、3年总生存率分别为83.3%、83.3%、66.7%,71.6%、37.3%、22.3%和25.0%、25.0%、0%,P=0.024。辅助化疗和未辅助化疗患者的1、2、3年总生存率分别为76.1%、46.3%、29.3%和62.2%、28.9%、15.6%,P=0.036。近期疗效为CR+PR和SD+PD患者的1、2、3年总生存率分别为73.5%、42.9%、27.2%和50.0%、14.3%、0%,P=0.004。②局部控制率的单因素分析:T1+2期和T3期患者的1、2、3年局部控制率分别为85.8%、67.7%、55.9%和65.4%、38.4%、38.4%,P=0.025。GTV120cm3和GTV≥120cm3患者的1、2、3年局部控制率分别为84.5%、70.8%、57.8%和68.2%、37.9%、37.9%,P=0.027。辅助化疗和未辅助化疗患者的1、2、3年局部控制率分别为80.8%、63.1%、58.2%和69.8%、39.7%、29.4%,P=0.017。单纯放疗、同步放化疗和序贯放化疗患者的1、2、3年局部控制率分别为69.8%、39.7%、29.4%,87.5%、77.4%、70.4%和77.1%、55.6%、51.9%,P=0.025。近期疗效为CR+PR和SD+PD患者的1、2、3年局部控制率分别为75.7%、59.3%、52.0%和84.4%、12.1%、12.1%,P=0.040。③多因素分析显示性别、ECOG评分、辅助化疗和近期疗效是影响总生存率的独立预后因素,GTV大小、辅助化疗和近期疗效是影响局部控制率的独立预后因素。5手术组首次失败为局部区域复发21例(32.8%),远处转移23例(35.9%),同时出现局部区域复发+远处转移1例(1.6%);放疗组首次失败为局部区域复发36例(31.9%),远处转移47例(41.6%),同时出现局部区域复发+远处转移5例(4.4%)。6放疗组≥2级放射性肺炎15例,占13.3%;≥2级放射性食管炎6例,占5.3%;≥2级血液学毒性反应20例,占17.7%。结论:1手术治疗和放射治疗在临床分期为IIIA-N2期非小细胞肺癌的总生存率、局部控制率、无远处转移生存率和无病生存率方面均未显示出统计学差异。2全组患者中女性、ECOG评分为0分、辅助化疗的患者总生存率较好。3术后放疗可以提高IIIA-N2期非小细胞肺癌的总生存率和局部控制率。4 N2阳性淋巴结数目是影响术后复发的独立影响因素,N2阳性淋巴结数目≤3的患者其局控率较高。5对于未手术患者,行辅助化疗及疗效评价达CR+PR的其生存和局控均较好。6大体肿瘤体积是影响局部控制率的独立因素,体积小者其局控较好。
[Abstract]:Objective: To compare the curative effect of surgical treatment and radiotherapy for stage IIIA-N2 non-small cell lung cancer (NSCLC) and analyze the prognostic factors. There were 113 patients in group R, 144 males and 33 females, with a median age of 64 years and a median follow-up period of 19 months (0.5-57.5 months). Overall survival rates (OS), local control rates (LC), and no distant metastasis survival rates (FDM) were calculated by Kaplan-Meier method. Disease-free survival rates (DFS), Logrank univariate analysis, Cox regression model multivariate analysis, P 0.05 was defined as statistically significant differences. Results: 1 The overall 1,2,3-year survival rates were 70.4%, 38.9%, 26.1%, 1,2,3-year local control rates were 73.6%, 54.6%, 47.8%, 1,2,3-year distant metastasis-free, respectively. The survival rates were 66.3%, 48.1%, 40.2%, 49.4%, 27.7% and 20.5% respectively. Multivariate analysis showed that gender, ECOG score and adjuvant chemotherapy were independent prognostic factors affecting the overall survival rate. 2 The median survival time and 1,2,3-year overall survival rates were 21 months, 70.2%, 38.3%, 30.1% and 19. There was no significant difference in 1,2,3-year local control rate (P = 0.840), distant metastasis-free survival rate (P = 0.622) and disease-free survival rate (P = 0.913) between the two groups. Posterior adjuvant therapy, adjuvant chemotherapy and adjuvant radiotherapy had better survival, N2 lymph node number < 3, single station N2 lymph node metastasis and adjuvant radiotherapy had higher local control rate. Independent prognostic factors of partial control rate. 4. Univariate analysis of overall survival rate: 1, 2, and 3-year overall survival rates were 68.8%, 34.4%, 20.1% and 78.9%, 63.2%, 41.4%, P = 0.033. The 1, 2, and 3-year overall survival rates were 83.3%, 83.3%, 66.7%, 71.6%, 37.3% and 22.3% for patients with 0, 1 and 2 ECOG scores, respectively. 3% and 25.0%, 25.0%, 0%, P = 0.024. The 1, 2, and 3-year overall survival rates of adjuvant chemotherapy and non-adjuvant chemotherapy were 76.1%, 46.3%, 29.3% and 62.2%, 28.9%, 15.6%, P = 0.036, respectively. The short-term efficacy was 73.5%, 42.9%, 27.2% and 50.0%, 14.3%, 0%, P = 0.004. The 1,2,3-year local control rates were 85.8%, 67.7%, 55.9% and 65.4%, 38.4%, 38.4%, P = 0.025. The 1,2,3-year local control rates of patients with GTV 120cm 3 or GTV more than 120cm 3 were 84.5%, 70.8%, 57.8% and 68.2%, 37.9%, 37.9%, P = 0.027. The 1,2,3-year local control rates of patients with adjuvant chemotherapy and those without adjuvant chemotherapy were 80.8%, 63.1%, 58.2% and 69.8%, respectively. The 1,2,3-year local control rates of CR+PR and SD+PD patients were 69.8%, 39.7%, 29.4%, 87.5%, 77.4%, 70.4% and 77.1%, 55.6%, 51.9%, P = 0.025, respectively. The short-term efficacy of CR+PR and SD+PD patients was 75.7%, 59.3%, 52.0% and 84.4%, 12.1%, P = 0.040.3, respectively. Gender, ECOG score, adjuvant chemotherapy and short-term outcome were independent prognostic factors affecting overall survival rate. GTV size, adjuvant chemotherapy and short-term efficacy were independent prognostic factors affecting local control rate. 1 case (1.6%) had local recurrence, 47 cases (41.6%) had distant metastasis, and 5 cases (4.4%) had local recurrence and distant metastasis. The overall survival rate, local control rate, distant metastasis-free survival rate and disease-free survival rate of patients with stage IIIA-N2 non-small cell lung cancer were not significantly different between treatment and radiotherapy. Total survival rate and local control rate of cell lung cancer were independent factors affecting postoperative recurrence. Patients with N2 positive lymph nodes less than 3 had a higher local control rate. The independent factor of the rate is smaller, and its control is better.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

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