Ⅰ期非小细胞肺癌术后的预后分析
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摘要
目的探讨Ⅰ期肺癌术后复发转移的相关因素。方法收集2010年1月至2015年12月在宁波市第二医院接受手术治疗并定期复查的251例Ⅰ期肺癌患者病历资料,对术后复发转移因素进行分析。结果 251例患者中局部复发与远处转移47例,复发转移率18.7%;中位随访时间43.1(9.5～97.2)个月。单因素分析显示不同性别、年龄、病理类型、分化程度、是否化疗、肿瘤最大径、胸膜侵犯及脉管癌栓的术后复发转移率差异无统计学意义(P>0.05),不同的清扫淋巴结个数(≤15个和>15个)以及不同的术前血清CEA浓度(>5 ng/ml和≤5 ng/ml)术后复发转移率差异有统计学意义(P<0.05)。多因素分析显示,清扫淋巴结≤15个及术前血清CEA浓度>5 ng/ml为肺癌术后复发转移高危因素。结论术前血清CEA浓度>5 ng/ml及清扫淋巴结≤15个患者,术后应积极随访。
Objective To analyze the related factors of recurrence and metastasis after operation of stage Ⅰ lung cancer. Methods Retrospective analysis of 251 cases of stage Ⅰ lung cancer was rechecked and diagnosed in our hospital. Statistical analysis of the relevant factors of recurrence postoperatively was made. Results There were 47 cases of recurrence in 251 cases with the recurrence rate reaching 18.7%. The median follow-up time of the whole people was 43.1 months. The recurrence of lung cancer patients showed no significant difference in different gender, age, pathological types, degree of differentiation, diseased region, maximum tumor diameter and pleural invasion and vascular tumor thrombus(P>0.05). Different number of lymph node dissection(≤15,>15) and different concentration of preoperative CEA(>5 ng/ml,≤5 ng/ml) were significantly different in single factor analysis(P<0.05). The number of lymph node dissection less than 15 and preoperative CEA concentration higher than 5 ng/ml were the best regression equation. Conclusions Preoperative CEA concentration higher than 5 ng/ml and the number of lymph node dissection less than 15 are independent risk factors. These patients should be fellow up actively after resection.
Objective To analyze the related factors of recurrence and metastasis after operation of stage Ⅰ lung cancer. Methods Retrospective analysis of 251 cases of stage Ⅰ lung cancer was rechecked and diagnosed in our hospital. Statistical analysis of the relevant factors of recurrence postoperatively was made. Results There were 47 cases of recurrence in 251 cases with the recurrence rate reaching 18.7%. The median follow-up time of the whole people was 43.1 months. The recurrence of lung cancer patients showed no significant difference in different gender, age, pathological types, degree of differentiation, diseased region, maximum tumor diameter and pleural invasion and vascular tumor thrombus(P>0.05). Different number of lymph node dissection(≤15,>15) and different concentration of preoperative CEA(>5 ng/ml,≤5 ng/ml) were significantly different in single factor analysis(P<0.05). The number of lymph node dissection less than 15 and preoperative CEA concentration higher than 5 ng/ml were the best regression equation. Conclusions Preoperative CEA concentration higher than 5 ng/ml and the number of lymph node dissection less than 15 are independent risk factors. These patients should be fellow up actively after resection.
引文
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[12] Ichinose Y, Hara N, Ohta M, et al. Is T factor of the TNM staging system a predominant prognostic factor in pathologic stage I non-small-cell lung cancer? A multivariate prognostic factor analysis of 151 patients[J]. J Thorac Cardiovasc Surg,1993,106(1):90-94.
[13] Martini N,Bains MS,Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer[J]. J Thorac Cardiovasc Surg,1995,109(1):120-129.
[2] 钟殿胜, 陈宝元. 早期肺癌诊断的进展[J].临床内科杂志,2010,27(4):224-226.
[3] 周箴, 廖美琳, 韩宝惠. Ⅰ期非小细胞肺癌术后影响复发转移和生存率的原因分析[J].肿瘤,2002,22(2):131-133.
[4] Okada M, Sakamoto T, Nishio W, et al. Characteristics and prognosis of patients after resection of nonsmall cell lung carcinoma measuring 2 cm or less in greatest dimension[J]. Cancer, 2003,98(3):535-541.
[5] Hung JJ, Jeng WJ, Hsu WH, et al. Predictors of death, local recurrence, and distant metastasis in completely resected pathological stage-I non-small-cell lung cancer[J]. J Thorac Oncol, 2012,7(7):1115-1123.
[6] Kato H1, Tsuboi M, Kato Y,et al. Postoperative adjuvant therapy for completely resected early-stage non-small cell lung cancer[J]. Int J Clin Oncol,2005,10(3):157-64.
[7] Lu X. Postoperative adjuvant therapy for completely resected early-stage non-small cell lung cancer[J]. Zhongguo Fei Ai Za Zhi, 2008,11(3):457-461.
[8] Nagashima T, Sakao Y, Mun M, et al. A clinicopathological study of resected small-sized squamous cell carcinomas of the peripheral lung: prognostic significance of serum carcinoembryonic antigen levels[J]. Ann Thorac Cardiovasc Surg, 2013,19(5):351-357.
[9] Wang J, Jiang W, Zhang T, et al. Increased CYFRA 21-1, CEA and NSE are Prognostic of Poor Outcome for Locally Advanced Squamous Cell Carcinoma in Lung: A Nomogram and Recursive Partitioning Risk Stratification Analysis[J].Transl Oncol,2018,11(4):999-1006.
[10] Sawyer TE, Bonner JA, Gould PM, et al. Patients with stage I non-small cell lung carcinoma at postoperative risk for local recurrence, distant metastasis, and death: implications related to the design of clinical trials[J]. Int J Radiat Oncol Biol Phys, 1999,45(2):315-321.
[11] Maeda R, Yoshida J, Ishii G, et al. Risk factors for tumor recurrence in patients with early-stage (stage I and Ⅱ) non-small cell lung cancer: patient selection criteria for adjuvant chemotherapy according to the seventh edition TNM classification[J]. Chest, 2011,140(6):1494-1502.
[12] Ichinose Y, Hara N, Ohta M, et al. Is T factor of the TNM staging system a predominant prognostic factor in pathologic stage I non-small-cell lung cancer? A multivariate prognostic factor analysis of 151 patients[J]. J Thorac Cardiovasc Surg,1993,106(1):90-94.
[13] Martini N,Bains MS,Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer[J]. J Thorac Cardiovasc Surg,1995,109(1):120-129.