纵隔淋巴结包膜外软组织受侵对Ⅲ<sub>A</sub>—N<sub>2</sub>期NSCLC术后放疗效果的预测作用

doi:10.3760/cma.j.issn.1004-4221.2016.12.005

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摘要

目的探讨淋巴结包膜外软组织受侵(ECE)对Ⅲ_A—N₂期NSCLC术后放疗效果的预测价值。方法共纳入2008—2009年220例术后Ⅲ_A—N₂期NSCLC患者,均接受了术后化疗,其中 43例接受了术后放疗;按ECE (+)和ECE (-)分成两组,然后依照术后单纯化疗(non-PORT)和术后同步放化疗(PORT)行亚组分析。采用Kaplan-Meier法计算PFS、OS并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果单因素分析显示ECE (-)组PFS、OS均优于ECE (+)组(P=0.000、0.000);ECE+组内PORT亚组和non-PORT亚组间PFS、OS均相近(P=0.584、0.723),ECE (-)组内PORT亚组PFS明显优于non-PORT亚组(P=0.039),但OS相近(P=0.125)。多因素分析提示ECE是影响Ⅲ_A—N₂期非小细胞肺癌PFS和OS的独立预后因素(P=0.001、0.020)。结论 ECE是Ⅲ_A—N₂期NSCLC的独立预后因素,它有可能作为Ⅲ_A—N₂期NSCLC术后放疗选择的依据。

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	张宝忠
	袁智勇
	赵路军
	庞青松
	王平

关键词 ：癌, 非小细胞肺/术后放射疗法, 癌, 非小细胞肺/术后化学疗法, 包膜外软组织受侵, 预后因素

Abstract：

Objective To investigate the value of extracapsular extension (ECE) in prediction of the efficacy of postoperative radiotherapy (PORT) in the treatment of stage Ⅲ_A—N₂ non-small cell lung cancer (NSCLC). Methods From 2008 to 2009, 220 patients with stage Ⅲ_A—N₂ NSCLC who received surgical treatment were enrolled as subjects. All patients received postoperative chemotherapy and 43 out of them received PORT. Those patients were divided into ECE (+) group and ECE (-) group, which were further divided into subgroups according to whether PORT was applied or not. Progression-free survival (PFS) and overall survival (OS) rates were calculated using the Kaplan-Meier method and analyzed using log-rank test. Univariate and multivariate prognostic analyses were conducted using the log-rank test and the Cox model, respectively. Results The univariate analysis showed that the ECE (-) group had significantly improved PFS and OS rates than the ECE (+) group (P=0.000, 0.000). In the ECE (+) group, there were no significant differences in PFS or OS rate between the PORT subgroup and the non-PORT subgroup (P=0.584, 0.723). In the ECE (-) group, the PORT subgroup had a significantly improved PFS rate than the non-PORT subgroup (P=0.039), while there was no significant difference in OS rate between the two subgroups (P=0.125). The multivariate analysis indicated that ECE was an independent prognostic factor for PFS and OS rates in patients with stage Ⅲ_A—N₂ NSCLC (P=0.001, 0.020). Conclusions ECE is an independent prognostic factor for stage Ⅲ_A—N₂ NSCLC and promises to provide a basis for the use of PORT in the treatment of stage Ⅲ_A—N₂ NSCLC.

Key words： Carcinoma,non-small cell lung/postoperative chemotherapy Carcinoma,non-small cell lung/postoperative radiotherapy Extracapsular extension Prognostic factor

收稿日期: 2016-08-11

通讯作者: 王平,Email:ping_wang2016@163.com

引用本文:

张宝忠,袁智勇,赵路军等. 纵隔淋巴结包膜外软组织受侵对Ⅲ_A—N₂期NSCLC术后放疗效果的预测作用[J]. 中华放射肿瘤学杂志, 2016, 25(12): 1295-1300.

Zhang Baozhong,Yuan Zhiyong,Zhao Lujun et al. Extracapsular extension in prediction of the efficacy of postoperative radiotherapy in the treatment of stage Ⅲ_A—N₂ non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(12): 1295-1300.

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