摘要
目的探讨第8版TNM分期模式下淋巴结状态对非小细胞肺癌手术患者的预后影响,评价N分期的异质性。方法回顾性分析2005年1月至2014年12月间1 851例行肺癌根治手术患者的临床资料,其中男1 078例、女773例,年龄16~86(59.7±9.7)岁。根据淋巴结的状态对N分期进行亚组分析,采用Kaplan-Meier方法计算不同分组之间的生存率,用log-rank检验比较组间差异。结果全组包括1 209例N0患者,305例N1患者和337例N2患者。N0患者根据是否对第13、14组淋巴结分检分为N0a组和N0b组,N0a组的生存率显著高于N0b组,5年生存率分别为88.9%和81.3%(P<0.001)。根据是否为多站淋巴结转移将N1分为单站(N1a)组和多站(N1b)组,两组生存率差异无统计学意义(P=0.562)。根据是否存在第10~12组淋巴结转移将N1患者分为阴性组和阳性组,阴性组的5年生存率显著高于阳性组(78.4%vs.64.3%,P=0.007)。N2患者分为单站转移(N2a1)组、单站伴N1阳性(N2a2)组和多站转移(N2b)组,分别占22.0%(74/337)、37.7%(127/337)和40.3%(136/337),三组间的生存率差异有统计学意义,5年生存率分别为62.2%、56.5%和37.3%(P=0.001)。结论对非小细胞肺癌术后患者的N分期进行亚组分析,组间有显著的生存差异,对N分期的进一步细分可能更契合精准分期模式下的多学科治疗。
Objective To evaluate the prognosis of different node status on the basis of the eighth TNM classification for lung cancer. Methods We retrospectively reviewed the clinical data of 1 851 non-small cell lung cancer （NSCLC） patients who underwent radical resection between January 2005 and December 2014. There were 1 078 males and 773 females at age of 16-86 （59.7±9.7） years. Survival probability was estimated by the Kaplan-Meier method and significance was assessed by the log-rank test. Results This cohort study was consisted of 1 209 patients with NO, 305 with N1 and 337 with N2. NO patients were divided into a N0a group and a NOb group according to whether the 13 and 14 level of lymph nodes were examined. The survival rate of the N0a group was significantly higher than that of the NOb group, and the 5-year survival rate was 88.9% and 81.3% （P〈0.001）, respectively. According to the number of lymph node metastasis stations, N1 was divided into a Nla （single） group and a Nlb （multiple） group. And no significant difference was observed between the two groups in survival rate （P=0.562）. Based on the presence of lymph nodes of 10-12 level, N 1 was divided into a negative group and a positive group. And the negative group was found with significantly higher survival rate than the positive group （5-year survival rate of 78.4% vs. 64.3%, P=0.007）. The N2 patients were divided into a single station metastasis group （a N2al group）, a single station with N1 positive group （a N2a2 ~roup） and a multiple
作者
李少雷
阎石
马媛媛
张善渊
鲁方亮
杨跃
LI Shaolei;YAN Shi;MA Yuanyuan;ZHANG Shanyuan;LU Fangliang;YANG Yue(Department of Thoracic Surgery , Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education）, Peking University Cancer Hospital and Institute, Beijing, 100142, P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第5期387-392,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
首都卫生发展科研专项(2014-2-1021)
北京市医管局临床医学发展专项-"扬帆"计划(ZYLX201509)
北京大学临床医学院合作专项
关键词
非小细胞肺癌
淋巴结转移
N分期
手术
预后
Non-small lung cancer
node metastasis
N Staging
surgery
prognosis
