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中央型占位对术后N2非小细胞肺癌患者预后的影响

Impact of central location on postoperative prognosis of N2 non-small-cell lung cancer

    摘要
  • 摘要:
    目的 探讨中央型占位对接受手术的N2型非小细胞肺癌患者预后的影响。
    方法 回顾性分析2005年1月至2015年12月复旦大学附属中山医院胸外科收治的657例N2型淋巴结转移的非小细胞肺癌患者的临床资料，根据是否存在中央支气管侵犯和阻塞性肺炎，将患者分为中央型组（n=157）和非中央型组（n=500），结合预后进行单因素和多因素分析。
    结果 657例患者中，中央型组男性患者比例更高（79.0% vs 58.6%），全肺和袖式切除术比例更高（15.3% vs 0.2%，10.2% vs 1.6%），鳞癌患者更多（57.3% vs 16.6%），肿瘤更大（40.2 mm vs 32.9 mm），累及胸膜比例更低（46.5% vs 65.4%），差异均有统计学意义（P < 0.05）。中央型组和非中央型组的5年生存率分别为27.2%和44.8%（P < 0.001），年龄、肿瘤大小、手术方式、N分期、有无放化疗、是否中央型占位是患者手术预后的独立影响因素（P < 0.05），其中中央型HR为1.38（P=0.016）。在602例接受标准肺叶切除患者中，中央型占位是影响其预后的独立危险因素（HR=1.34，P=0.032）。中央型鳞癌和腺癌患者5年生存率均低于非中央型患者（32.7% vs 36.0%，P=0.678；19.4% vs 48.1%，P < 0.001），其中，中央型占位是影响腺癌患者预后的独立危险因素（HR=2.30，95%CI 1.51~3.50，P < 0.001）。
    结论 对于N2淋巴结转移的非小细胞肺癌手术患者，中央型占位是不良预后因素；这种表现在腺癌患者中更为明显，N2中央型腺癌患者手术后的预后较差，选择手术时应更加慎重。

     

    Abstract:
    Objective To explore the impact of central location tumor on the prognosis of stage N2 non-small-cell lung cancer (NSCLC) after surgery.
    Methods Clinical characteristics of 657 NSCLC patients with N2 lymph nodes metastasis, who underwent surgery at the Department of Thoracic of Zhongshan Hospital, Fudan University from January 2005 to December 2015, were retrospectively analyzed. Patients were divided into central location group (n=157) and non-central group (n=500) based on if the tumor had main bronchus invasion or obstructive pneumonia, and were analyzed through univariate and multivariate Cox regression methods with prognosis data.
    Results Among the 657 patients included, the central location group had higher rate of male patients (79.0% vs 58.6%), more pneumonectomy and sleeve lobectomy (15.3% vs 0.2%, 10.2% vs 1.6%), more squamous cell carcinoma (57.3% vs 16.6%), larger tumor size (40.2 mm vs 32.9 mm), and lower rate of pleural invasion (46.5% vs 65.4%, P < 0.05). The 5-year overall survival rate of central location and non-central group patients was 27.2% and 44.8%, respectively (P < 0.001), age, tumor size, surgery method, N stage, chemoradiation, and central location were independent factors correlated with postoperative prognosis of patients. Hazard ratio (HR) of central location group compared to non-central group was 1.38 (P=0.016). Among the 602 patients receiving standard lobectomy, central location was also an independent risk factor associated with prognosis (HR=1.34, P=0.032). The 5-year overall survival rate of central location group was lower than non-central group patients among both squamous cell carcinoma and adenocarcinoma patients (32.7% vs 36.0%, P=0.678; 19.4% vs 48.1%, P < 0.001), central location was the independent risk factor correlated with postoperative prognosis of adenocarcinoma patients (HR=2.30, 95%CI 1.51-3.50, P < 0.001).
    Conclusions Central location tumor is an unfavorable factor for postoperative prognosis of NSCLC patients with N2 lymph nodes metastasis. The difference is more obvious among adenocarcinoma patients, surgery decision should be more cautious for central location adenocarcinoma with N2 metastasis because of their relatively poor survival.

     

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