高龄非小细胞肺癌患者胸腔镜手术后生存预后因素分析
摘要
分析高龄非小细胞肺癌(non-small cell lung cancer,NSCLC)患者胸腔镜手术后预后因素。选取2011年1月至2014年1月,福建医科大学附属泉州第一医院收治的高龄非小细胞肺癌患者112例,均行胸腔镜手术治疗。对患者随访32.6 (6~61)个月,统计患者生存情况,分析预后影响因素,采用KaplanMeier法绘制生存曲线,比较不同因素对生存的影响。结果显示,112例患者未出现围术期死亡者,出现轻微并发症12例(10.71%)。死亡33例,中位总生存期38个月,1年生存率为85.71%(96/112),3年生存率为70.54%(79/112),复发率为6.25%(7/112),其中局部复发5例,远处转移2例。单因素分析显示周围型病变、病理分期Ⅰ期、肿瘤直径≤3cm、病理类型非鳞癌、病理分化中/高分化、术后规范化疗、查尔森合并症指数(charlson comorbidity index,CCI)≤5分、脉管内栓瘤阴性患者具有更长生存期。COX回归模型分析显示,病变部位(HR=3.935,95%CI=1.562~9.920);肿瘤直径(HR=2.832,95%CI=1.467~5.473);病理分化(HR=2.002,95%CI=1.046~3.835);CCI (HR=3.910,95%CI=1.756~8.709);脉管内栓瘤(HR=1.153,95%CI=0.715~4.125)是影响NSCLC高龄患者胸腔镜手术术后生存的独立预后危险因素,而术后化疗(HR=4.256,95%CI=2.774~10.936)为保护性因素。胸腔镜手术是早期高龄NSCLC患者安全有效的治疗方法,术后远期生存率与病变部位、肿瘤直径、病理分化、术后化疗、CCI、脉管内栓瘤等因素密切相关,规范化化疗是患者预后的保护性因素,加强术前综合评估,规范术后辅助化疗及指导预后。
引文
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[2] Siegel RL,Miller KD,Jemal A.Cancer statistics,2015[J].Cancer J Clin,2015,65(1):5-29.
[3]National Lung Screening Trial Research Team.Reduced lungcancer mortality with low-dose computed tomographic screening[J].N Engl J Med,2011,365(5):395-409.
[4] Ochiai T,Masuda T,Yagi M,et al.Successful combination therapy of radical liver resection with 5-Fluorouracil/leucovorin,Oxaliplatin,plus bevacizumab for ascending colon cancer With pulmonary and 43liver metastases:report of a case[J].Int Surg,2012,97(1):6-13.
[5]Watanabe A,Mishina T,Ohori S,et al.Is video-assisted thoracoscopic surgery a feasible approach for clinical N0and postoperatively pathological N2non-small cell lung cancer[J].Eur J Cardiothorac Surg,2008,33(5):812-818.
[6] Congregado M,Merchan RJ,Gallardo G,et al.Video-assisted thoracic surgery(VATS)lobectomy:13years'experience[J].Surg Endosc,2008,22(8):1852-1857.
[7]颖猛,黄伟钊,姜海明,等.胸腔镜下亚肺叶切除及纵隔淋巴结采样治疗早期非小细胞肺癌[J].广东医学,2013,34(8):1203-1204.
[8] McKenna RJ,Houck W,Fuller CB.Video-assisted thoracic surgery lobectomy:experience with 1100cases[J].Ann Thorac Surg,2006,81(2):421-426.
[9] Blanco R,Maestu I,de la Torre MG,et al.A review of the management of elderly patients with non-small-cell lung cancer[J].Ann Oncol,2015,26(3):451-463.
[10]李运,王俊,隋锡朝,等.全胸腔镜肺叶切除手术操作流程及技巧的优化:北京大学人民医院经验[J].中华胸心血管外科杂志,2010,26(5):300-306.
[11] Ohtsuka T,Nomori H,Horio H,et al.Is major pulmonary resection by video-assisted thoracic surgery an adequate procedure in clinical stage I lung cancer[J].Chest,2004,125(125):1742-1746.
[12] Yamashita SI,Chujo M,Kawano Y,et al.Clinical impact of segmentectomy compared with lobectomy under complete videoassisted thoracic surgery in the treatment of stage I non-small cell lung cancer[J].J Sur Res,2011,166(1):46-51.
[13] Boorjian SA,Frank I,Inman B,et al.The role of partial nephrectomy for the management of sporadic renal angiomyolipoma[J].Urology,2007,70(6):1064-1068.
[14] Luo Y,Hou G,Lu M,et al.Unclamped nephron-sparing surgery with preoperative selective arterial embolization for the management of bilateral giant renal angiomyolipomas[J].Clin Genitourin Cancer,2014,12(3):111-114.
[15]林潇,陈愉生,李鸿茹,等.非小细胞肺癌淋巴结转移与临床病理特征及预后的相关性分析[J].临床肿瘤学杂志,2015,20(12):1110-1116.
[16] Zhang Y,Sun Y,Xiang J,et al.A prediction model for N2disease in T1non-small cell lung cancer[J].J Thorac Cardiovasc Surg,2012,144(6):1360-1364.
[17]Detterbeck FC,Boffa DJ,Tanoue LT,et al.The new lung cancer staging system.[J].Chest,2009,136(1):260-271.
[18] Howington JA,Blum MG,Chang AC,et al.Treatment of stageⅠandⅡnon-small cell lung cancer:diagnosis and management of lung cancer,3rd ed:American College of Chest Physicians evidencebased clinical practice guidelines[J].Chest,2013,143(5Suppl):e278S-313S.
[19]刘树库,许绍发,刘志东,等.Ⅰ期非小细胞肺癌的肿瘤大小对其预后的影响[J].中国肺癌杂志,2006,9(1):178-182.
[20] Sun Z,Aubry MC,Deschamps C,et al.Histologic grade is an independent prognostic factor for survival in non-small cell lung cancer:an analysis of 5018hospital-and 712population-based cases[J].J Thorac Cardiovasc Surg,2006,131(5):1014-20.
[21]张亚飞,刘攀,赵化荣,等.肺腺癌根治术后复发与转移的预后因素分析[J].国际肿瘤学杂志,2016,43(4):254-257.
[22] Rueth NM,Parsons HM,Habermann EB,et al.Surgical treatment of lung cancer:predicting postoperative morbidity in the elderly population[J].J Thorac Cardiovasc Surg,2012,143(6):1314-1323.