Ⅲa期单站纵隔淋巴结肿大NSCLC患者术后生存分析

目的 分析单站N2-Ⅲa期非小细胞肺癌患者的预后因素。方法 回顾性分析2010年1月至2013年12月同济大学附属肺科医院的术后病理确诊为单站纵膈淋巴结转移的N2-Ⅲa期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者341例。收集所有患者的基本临床病理资料及术后治疗,并进行生存随访；采用Kaplan-Meier方法绘制生存曲线,Cox比例风险模型对无病生存期(disease free survival, DFS)和总生存期(overall survival, OS)进行多因素分析。结果 所有患者的中位DFS及中位OS分别为28个月和52个月。多因素分析显示肿瘤最大径≤3cm(P=0.010)、未侵及脏层胸膜(P=0.009)以及辅助化疗≥3周期(P=0.001)是单站N2-ⅢA期NSCLC患者无病生存的有利因素；而女性患者(P=0.046)、腺癌患者(P=0.004)、辅助化疗≥3周期(P=0.000)、单纯胸腔内复发(P=0.002)和复发后接受抗肿瘤治疗(P=0.000)是单站N2-Ⅲa期NSCLC的独立生存预后因素。结论肿瘤最大径≤3cm、未侵及脏层胸膜及辅助化疗≥3周期是单站N2-ⅢA期NSCLC患者复发预测因素；而女性、腺癌、辅助化疗≥3周期、单纯胸腔内复发及复发后接受抗肿瘤治疗是单站N2-Ⅲa期NSCLC患者的独立生存预后因素。
Objective To analyze the prognostic factors of non-small cell lung cancer(NSCLC) patients with single station pN2-ⅢA stage. Methods Three hundred and forty one NSCLC patients with single station pN2-ⅢA stage treated in Shanghai Pulmonary Hospital, Tongji University, between January 2010 and December 2013 were recruited in the study. The clinicopathological data and survival times were recorded. Kaplan-Meier method was used to calculate the disease-free survival(DFS), overall survival(OS)； and Cox regression was used for multivariate analysis. Results The median DFS and OS of the patients were 28 months and 52 months, respectively. Multivariate analysis demonstrated that tumor size≤3cm(P=0.010), non-invasion visceral pleura(P=0.009) and≥3cycles of chemotherapy(P=0.001) were the independent favorable prognostic factors for DFS； female sex(P=0.046), adenocarcinoma(P=0.004), ≥3cycles of chemotherapy(P=0.000), intrathoracic relapse(P=0.002) and antitumor therapy after recurrence(P=0.000) were the independent favorable prognostic factors for OS. Conclusion Tumor size, visceral pleural invasion and adjuvant chemotherapy are predictive factors for recurrence； female sex, adenocarcinoma, cycles of adjuvant chemotherapy, intrathoracic recurrence and therapy for recurrence are prognostic factors for NSLCL patients with single station pN2-Ⅲa stage