总结临床I期非小细胞肺癌(NSCLC)患者病例,分析肺内(N。)淋巴结转移的危险因素,以提高术前N分期的准确性,指导手术方式及治疗策略的制定。方法回顾性分析2006年9月至2013年12月手术治疗的612例NSCLC患者的临床资料。通过单因素及多因素分析筛选出临床I期NSCLC发生肺内淋巴结转移的独立危险因素。结果术后病理为pN,者59例(9.6%,59/612)。单因素分析显示,男性、吸烟史、肿瘤直径、肿瘤位置(中央型)、病理类型(非腺癌)、肿瘤分化程度及肿瘤周边脉管微浸润为临床I期NSCLC患者发生N,转移的危险因素。多因素分析显示肿瘤直径(OR=1.903,P<0.01)、肿瘤分化程度(or=2.591,p<0.01)和脉管浸润(or=6.170,p<0.01)是临床i期nsclc患者发生n,转移的独立危险因素。对肿瘤直径进行roc曲线分析,结果得出2 2="">2 cm时,N.转移率为15.O%(P=0。003)。结论临床I期NSCLC患者的肺内淋巴结转移率(pN,)为9.6%。肿瘤直径,肿瘤分化程度和脉管浸润为临床I期NSCLC肺内淋巴结转移(pN.)的独立危险因素。直径>2 cm的临床I期NSCLC患者术前应考虑行PET—CT或者EBUS—TBNA等有创检查以明确N分期。
评估多西他赛与顺铂每周方案诱导同步放化疗联合手术在Ⅲ。一N:期非小细胞肺癌治疗中的有效性和安全性。方法回顾性分析2011年3月至2013年11月18例Ⅲ。一N:期非小细胞肺癌患者,采用术前诱导放化疗+手术的治疗方案。诱导化疗为DP每周方案(多西他赛20 mg/m2+顺铂20mg/in2)5周期,同步放疗总剂量45 Gy;诱导治疗后非疾病进展期患者接受手术治疗;术后再给予DP方案辅助化疗。结果16例完成诱导治疗。诱导治疗出现Ⅲ级以上不良反应5例,其中中性粒细胞减少2例,肝脏损害、淋巴结感染、贫血各1例。诱导治疗后影像学完全缓解1例,部分缓解10例,疾病稳定6例,疾病进展1例。12例患者最终接受手术,中位手术时间290 min,出血量350 ml,带管时间5天,术后住院7天。纵隔淋巴结降期率为50%(3例pN0,3例pN,),92%的患者获得完全切除。1年生存率为75.9%,1年无进展生存率为49.2%。结论基于多西他赛+顺铂每周方案的诱导同步放化疗联合手术对Ⅲ。一N2期非小细胞肺癌患者的疗效确切,安全性良好。
讨全胸腔镜下肺叶切除术中肺动、静脉切断顺序对I一Ⅱ期ttd,细胞肺癌疗效的影响。方法回顾分析2006年9月至2012年12月行肺叶切除的I 134例患者中直接行全胸腔镜下肺叶切除术,且术后病理证实为I一Ⅱ期tN,细胞肺癌者277例的资料。根据血管处理顺序分为先断静脉组(Group V)152例、先断动脉组(Group A)76例、动脉一静脉一动脉混合离断组(Group M)49例。比较3组术前、术中情况及术后生存、复发情况。结果3组性别分布、年龄、吸烟史、肺部感染史、主要并发症、既往肿瘤病史、病变直径、术前肿瘤标志物及术前肺功能相似。Group A组平均术中出血109.9m1,明显少于Group V组的157.5 ml,而Group M介于两者之间为123.7 ml(P=0.027)。3组手术时间术后并发症情况相似;he瘤复发方式相似,均以远处转移为主;无瘤生存时间及总生存时间差异均无统计学意义。结论对于全胸腔镜下治疗I~Ⅱ期非小细胞肺癌,先处理并切断动脉可减少术中出血,并未减少手术难度和术后并发症;血管处理顺序不影响肿瘤复发、转移和生存,可根据术中需要合理选择。
Video-assisted thoracoscopic surgery is more favorable than thoracotomy for administration of adjuvant chemotherapy after lobectomy for non-small cell lung cancer.Guanchao Jiang, Fan Yang, Xiao Li, Jun Liu, Jianfeng Li, Hui Zhao, Yun Li and Jun Wang*Abstract Background: Video-assisted thoracoscopic surgery (VATS) lobectomy is a newly developed type of surgery for lung cancer and has been demonstrated obvious minimally-invasive advantages compared with traditional thoracotomy. Theoretically, that less trauma leads to quicker recovery and may facilitate administration of adjuvant chemotherapy. We tested this hypothesis in this study. Methods: One hundred and ten NSCLC patients underwent lobectomy and adjuvant chemotherapy from June 2004 to June 2010 was analyzed. The baseline characteristic criteria, variables related to surgery and accomplishing status of chemotherapy were analyzed. Results: All 110 patients underwent lobectomy through VATS (n = 54) or thracotomy (n = 56) and adjuvant chemotherapy. There was no significant difference in patients’ age, preoperative pulmonary function, co-morbidity,pathologic staging between the two groups, whereas, blood loss, operation time and postoperative complications, chest tube duration and length of stay were less in VATS group. There were no significant differences in time to initiation chemotherapy. Cases in VATS group received more cycles of chemotherapy (3.6 vs. 3.0, p = 0.002). A higher proportion of patients received full dose on schedule in VATS group (57.4% vs. 33.9%, p = 0.013) and a higher proportion of patients completed ≥75% planed dose, (88.9% vs. 71.4%, p = 0.022); slightly higher proportion of patients in thoracotomy group had grade 3 or more toxicity (20.4% vs. 35.7%, p = 0.074). Conclusions: Patients underwent lobectomy by VATS have better compliance and fewer delayed or reduced dose on adjuvant chemotherapy than those by thoracotomy.