羅猛,劉波,劉迪,胡劍,龍謙,張慶斌,梅宏
(貴州省人民醫(yī)院 胸外科,貴州 貴陽 550002)
非小細(xì)胞肺癌患者微創(chuàng)切除術(shù)后的復(fù)發(fā)與轉(zhuǎn)移狀況研究
羅猛,劉波,劉迪,胡劍,龍謙,張慶斌,梅宏
(貴州省人民醫(yī)院 胸外科,貴州 貴陽 550002)
目的分析非小細(xì)胞肺癌(NSCLC)患者微創(chuàng)切除術(shù)后的復(fù)發(fā)與轉(zhuǎn)移狀況。方法選取2008年1月-2013年12月該院行胸腔鏡下肺葉切除術(shù)的123例NSCLC患者為研究對象,統(tǒng)計(jì)其圍手術(shù)期資料和隨訪結(jié)果,記錄術(shù)后復(fù)發(fā)與轉(zhuǎn)移情況,采用多因素Logistic回歸分析術(shù)后復(fù)發(fā)與轉(zhuǎn)移的影響因素。結(jié)果全部患者的中位手術(shù)時(shí)間為165 min (60~430 min),中位術(shù)中出血量95 ml(20~3 100 ml),術(shù)后共出現(xiàn)15例(12.2%)并發(fā)癥。全部患者出院后均進(jìn)行定期隨訪,中位隨訪時(shí)間為23.5個(gè)月(6~69個(gè)月),隨訪期間分別有36例(29.3%)患者出現(xiàn)復(fù)發(fā),42例(34.1%)患者出現(xiàn)轉(zhuǎn)移;其中,有16例(13.0%)患者同時(shí)出現(xiàn)復(fù)發(fā)與轉(zhuǎn)移。同側(cè)肺部(52.8%)是最常見的復(fù)發(fā)部位,其次是縱隔淋巴結(jié)(38.9%),骨(28.6%)是最常見的轉(zhuǎn)移部位,其次是對側(cè)肺部(26.2%)、腦部(19.0%)。多因素Logistic回歸分析結(jié)果表明,Ⅱ~Ⅲ期、縱隔淋巴結(jié)轉(zhuǎn)移、低分化是患者出現(xiàn)術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素(P<0.05),Ⅱ~Ⅲ期、淋巴結(jié)轉(zhuǎn)移數(shù)目≥3個(gè)、術(shù)后無放化療是患者出現(xiàn)術(shù)后轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素(P<0.05)。結(jié)論對NSCLC患者而言,胸腔鏡下肺葉切除手術(shù)的術(shù)后復(fù)發(fā)、轉(zhuǎn)移主要發(fā)生在同側(cè)肺部與骨,TNM分期、縱隔淋巴結(jié)轉(zhuǎn)移、分化程度、淋巴結(jié)轉(zhuǎn)移數(shù)目、術(shù)后放化療與術(shù)后復(fù)發(fā)和轉(zhuǎn)移有關(guān)。
胸腔鏡;非小細(xì)胞肺癌;復(fù)發(fā);轉(zhuǎn)移;因素分析
肺癌是我國發(fā)病率最高的惡性腫瘤之一,隨著城市化與工業(yè)化的進(jìn)程加快,國內(nèi)肺癌的發(fā)病率呈逐年增長的趨勢,嚴(yán)重危害人們的健康和生活質(zhì)量。肺癌分為小細(xì)胞肺癌(small cell lung cancer,SCLC)及非小細(xì)胞肺癌(non-small cell lung cancer,NSCLC),對于NSCLC而言,手術(shù)治療仍然是其首選的治療方法,包括傳統(tǒng)開胸肺葉切除術(shù)與胸腔鏡下輔助肺葉切除術(shù)兩種術(shù)式。與傳統(tǒng)開胸手術(shù)相比,胸腔鏡下肺葉切除術(shù)具有創(chuàng)傷小、切口短、疼痛輕、術(shù)后并發(fā)癥低和恢復(fù)快等多個(gè)優(yōu)點(diǎn)[1],國內(nèi)胸腔鏡手術(shù)的開展時(shí)間較晚,近年來隨著顯微外科與微創(chuàng)手術(shù)理念的發(fā)展,胸腔鏡輔助手術(shù)的療效、安全性與可行性已得到廣泛認(rèn)同。盡管目前已有規(guī)范的微創(chuàng)手術(shù)操作,除非因術(shù)中視野受出血影響或組織血管粘連不易分離者需中轉(zhuǎn)開胸外,大部分患者可順利完成胸腔鏡下肺葉切除術(shù),然而,在隨訪中可發(fā)現(xiàn)仍有不少患者出現(xiàn)術(shù)后復(fù)發(fā)和轉(zhuǎn)移,影響了患者的遠(yuǎn)期生存狀況。本研究總結(jié)了2008年1月-2013年12月于本院行胸腔鏡下肺葉切除術(shù)的123例NSCLC患者的臨床資料及隨訪結(jié)果,重點(diǎn)分析其術(shù)后復(fù)發(fā)與轉(zhuǎn)移的發(fā)生狀況及影響因素,為臨床提供參考依據(jù)?,F(xiàn)報(bào)道如下:
選取2008年1月-2013年12月于本院行胸腔鏡下肺葉切除術(shù)的123例NSCLC患者為研究對象。其中,男72例,女51例;年齡33~83歲,平均(66.1±8.2)歲。入選標(biāo)準(zhǔn):①初治的原發(fā)性NSCLC,單側(cè)發(fā)病,且經(jīng)過病理學(xué)檢查確診;②手術(shù)均順利完成,無中轉(zhuǎn)開胸者;③術(shù)后TNM分期為Ⅰ~ⅢA期;④臨床資料及隨訪結(jié)果完整。排除標(biāo)準(zhǔn):①原位癌或合并有其他惡性腫瘤的患者;②行肺段切除術(shù);③術(shù)前行放療和化療等新輔助治療者;④非R0切除;⑤圍手術(shù)期死亡者或失訪者。
所有患者均采用常規(guī)全麻、雙腔氣管內(nèi)插管和單肺通氣,術(shù)中均采用3個(gè)切口,主操作口位于腋前線第4或5肋間,輔助操作口位于肩胛下線第7或8肋間,觀察口位于腋中線第7或8肋間的,與輔助操作口在同一肋間。術(shù)中均不采用開胸器,在電視輔助胸腔鏡下行肺葉切除術(shù),之后行系統(tǒng)地清掃縱隔淋巴結(jié),清掃范圍至少包括第7組淋巴結(jié)在內(nèi)的3站肺內(nèi)淋巴結(jié)與3站縱隔淋巴結(jié)。記錄所有患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)中清掃淋巴結(jié)的組數(shù)與總數(shù)、住院時(shí)間和術(shù)后并發(fā)癥情況等圍手術(shù)期指標(biāo),以及腫瘤部位、最大徑、術(shù)后病理類型、病理分期、淋巴結(jié)轉(zhuǎn)移數(shù)目、是否有縱隔淋巴結(jié)轉(zhuǎn)移和分化程度等臨床病理資料。
對所有出院患者進(jìn)行定期的電話或門診隨訪,截止時(shí)間為2016年12月,隨訪期間記錄患者有無出現(xiàn)復(fù)發(fā)或轉(zhuǎn)移以及出現(xiàn)的具體時(shí)間,復(fù)發(fā)指病灶局限于一側(cè)原腫瘤所在的胸腔,包括手術(shù)殘留、同側(cè)的肺、胸膜與縱隔淋巴結(jié);轉(zhuǎn)移指病灶發(fā)生在原腫瘤所在的對側(cè)胸腔或遠(yuǎn)處器官,包括對側(cè)的肺部、腦、肝、骨、腎上腺、頸部與鎖骨上淋巴結(jié)等。據(jù)此將所有患者分別歸為復(fù)發(fā)組與非復(fù)發(fā)組,轉(zhuǎn)移組與非轉(zhuǎn)移組。
所有資料均采用SPSS 18.0統(tǒng)計(jì)學(xué)軟件進(jìn)行分析,計(jì)量資料以樣本平均數(shù)±標(biāo)準(zhǔn)差(±s)表示,兩組比較用t檢驗(yàn),計(jì)數(shù)資料采用χ2檢驗(yàn),采用多因素Logistic回歸分析得出影響患者發(fā)生復(fù)發(fā)或轉(zhuǎn)移的獨(dú)立影響因素,以P<0.05視為差異具有統(tǒng)計(jì)學(xué)意義。
全部123例患者中均成功完成胸腔鏡下肺葉切除術(shù),手術(shù)時(shí)間60~430 min,中位時(shí)間為165 min,術(shù)中出血量20~3 100 ml,中位出血量為95 ml,術(shù)中清掃淋巴結(jié)的平均組數(shù)和個(gè)數(shù)分別為(4.7±1.6)和(11.3±4.0),平均住院時(shí)間為(8.9±3.7)d。術(shù)后共出現(xiàn)15例(12.2%)并發(fā)癥,包括持續(xù)漏氣(>1周)4例、持續(xù)心律失常4例、乳糜胸3例、肺部感染2例、胸腔積液1例和喉返神經(jīng)損傷1例。
全部123例患者出院后均進(jìn)行定期隨訪,隨訪時(shí)間為6~69個(gè)月,中位隨訪時(shí)間為23.5個(gè)月,隨訪期間分別有36例患者出現(xiàn)復(fù)發(fā),42例患者出現(xiàn)轉(zhuǎn)移,發(fā)生率分別為29.3%和34.1%;其中,有16例(13.0%)患者同時(shí)出現(xiàn)復(fù)發(fā)與轉(zhuǎn)移。詳見表1。
表1 復(fù)發(fā)與轉(zhuǎn)移部位Table1 Site of recurrence and metastasis
結(jié)果表明,年齡≥65歲、原發(fā)灶最大徑≥3 cm、Ⅱ~Ⅲ期、T2~T3期、N1~N2期、縱隔淋巴結(jié)轉(zhuǎn)移、淋巴結(jié)清掃總數(shù)≥10個(gè)、低分化、術(shù)后未放化療、2010~2011年的復(fù)發(fā)率明顯升高(P<0.05),年齡≥65歲、Ⅱ~Ⅲ期、T2~T3期、N1~N2期、縱隔淋巴結(jié)轉(zhuǎn)移、淋巴結(jié)轉(zhuǎn)移數(shù)目≥3個(gè)、淋巴結(jié)清掃總數(shù)≥10個(gè)、低分化、術(shù)后無放化療的轉(zhuǎn)移率明顯升高(P<0.05)。詳見表 2。
以是否出現(xiàn)術(shù)后復(fù)發(fā)、轉(zhuǎn)移為因變量Y1和Y2,將表2中的各因素進(jìn)行多因素Logistic回歸分析,結(jié)果表明,Ⅱ~Ⅲ期、縱隔淋巴結(jié)轉(zhuǎn)移、低分化是患者出現(xiàn)術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素(P<0.05),Ⅱ~Ⅲ期、淋巴結(jié)轉(zhuǎn)移數(shù)目≥3個(gè)、術(shù)后無放化療是患者出現(xiàn)術(shù)后轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素(P<0.05)。詳見表3。
表2 患者的臨床病理特征比較Table 2 Comparison of clinicopathological features of the patients
表2 續(xù)Table 2
表3 多因素Logistic回歸分析結(jié)果Table 3 Result of multivariate logistic regression analysis
胸腔鏡微創(chuàng)手術(shù)目前已被納入了美國國立綜合癌癥網(wǎng)絡(luò)的治療指南,但其對于腫瘤學(xué)治療的療效仍存在一定的爭議[2]。在我國,胸腔鏡微創(chuàng)手術(shù)開展較晚,以往的報(bào)道主要集中于圍手術(shù)期的狀況,近期療效普遍較好,但對患者術(shù)后的復(fù)發(fā)、轉(zhuǎn)移等遠(yuǎn)期預(yù)后的研究較少。國外對胸腔鏡手術(shù)的遠(yuǎn)期療效報(bào)道較多,主要以高加索人種為主[3],亞裔肺癌人群報(bào)道相對較少[4]。根據(jù)以往的系統(tǒng)回顧和Meta分析,胸腔鏡下肺葉切除術(shù)的手術(shù)時(shí)間78~288 min,術(shù)中出血量72~253 ml,術(shù)后引流時(shí)間為1.2~8.0 d,術(shù)后住院時(shí)間為4.1~23.0 d,圍手術(shù)期死亡率0.0%~2.5%[3,5-6]。本研究全部患者的平均手術(shù)時(shí)間為165 min,中位出血量為95 ml,平均住院時(shí)間為(8.9±3.7)d,與以往研究接近。術(shù)后并發(fā)癥方面,以往研究[3,7]報(bào)道其總發(fā)生率為7.7%~24.1%,本研究術(shù)后并發(fā)癥發(fā)生率為12.2%,主要包括持續(xù)漏氣、持續(xù)心律失常、乳糜胸,也與以往報(bào)道接近,總體而言,胸腔鏡微創(chuàng)手術(shù)對于NSCLC患者而言是安全可行的。
對于手術(shù)而言,術(shù)后的復(fù)發(fā)與轉(zhuǎn)移情況是衡量其成功與否的重要指標(biāo)之一,能部分反映手術(shù)的療效,但以往的各個(gè)研究報(bào)道不一。本研究的中位隨訪時(shí)間為23.5個(gè)月,期間復(fù)發(fā)和轉(zhuǎn)移的發(fā)生率分別為29.3%和34.1%,稍高于以往的開胸手術(shù)報(bào)道[8-11],這可能與隨訪時(shí)間長短、納入患者的分期等因素有關(guān)。發(fā)生部位方面,同側(cè)肺部是最常見的復(fù)發(fā)部位,術(shù)后轉(zhuǎn)移主要發(fā)生在骨與對側(cè)肺部,與VARLOTTO等[10]報(bào)道的開胸手術(shù)結(jié)果類似。多因素Logistic回歸分析結(jié)果表明TNM分期是影響患者術(shù)后是否出現(xiàn)復(fù)發(fā)與轉(zhuǎn)移的關(guān)鍵因素,分期越高者的惡性程度越高,手術(shù)根治的難度也越大,術(shù)后復(fù)發(fā)轉(zhuǎn)移的風(fēng)險(xiǎn)也越高,故對NSCLC患者而言,早期診斷和治療與其預(yù)后息息相關(guān)。張真榕等[12]研究表明TNM分期是NSCLC患者術(shù)后總體生存狀況的獨(dú)立影響因素,分期越高,術(shù)后生存期越短。本研究發(fā)現(xiàn)2010~2011年患者的術(shù)后復(fù)發(fā)率顯著高于2012~2013年,提示預(yù)后有逐年改善的趨勢,這除了與手術(shù)技術(shù)的成熟外,更重要的是NSCLC的早期診斷率有所升高,早期患者更容易被發(fā)現(xiàn),這與肺部高分辨率CT有關(guān),其提前了肺癌患者的診斷時(shí)間節(jié)點(diǎn),使早期肺癌的檢出率明顯增加,從而使其總體病死率降低了20%[13]。
本研究結(jié)果表明合并縱隔淋巴結(jié)轉(zhuǎn)移的NSCLC患者術(shù)后復(fù)發(fā)率明顯升高,淋巴結(jié)轉(zhuǎn)移數(shù)目≥3個(gè)的患者術(shù)后轉(zhuǎn)移率明顯提高,提示系統(tǒng)淋巴結(jié)的清掃對于其預(yù)后有關(guān)。楊廣愷等[14]研究表明與僅行肺切除術(shù)+肺門淋巴結(jié)清掃的對照組相比,行肺切除術(shù)+系統(tǒng)性縱隔淋巴結(jié)清掃的NSCLC患者術(shù)后復(fù)發(fā)與轉(zhuǎn)移率明顯降低,有助于提高長期生存率、改善生活質(zhì)量。以往臨床上有不少醫(yī)生認(rèn)為當(dāng)出現(xiàn)縱隔淋巴結(jié)轉(zhuǎn)移時(shí),胸腔鏡下難以行系統(tǒng)性淋巴結(jié)清掃,應(yīng)中轉(zhuǎn)開胸,但隨著微創(chuàng)技術(shù)的成熟和手術(shù)經(jīng)驗(yàn)的增加,國內(nèi)不少研究[15-16]均報(bào)道胸腔鏡與開胸手術(shù)的淋巴結(jié)清掃數(shù)目比較無顯著差異,一樣能徹底地完成系統(tǒng)性淋巴結(jié)清掃,故對縱隔淋巴結(jié)轉(zhuǎn)移者可首先考慮行胸腔鏡下肺葉切除術(shù)+系統(tǒng)性清掃淋巴結(jié)。此外,本研究還發(fā)現(xiàn)低分化的患者術(shù)后復(fù)發(fā)風(fēng)險(xiǎn)明顯高于中高分化者,與以往研究結(jié)果[17]類似,提示應(yīng)做好術(shù)前病理檢查和術(shù)后病理確認(rèn),病理學(xué)結(jié)果除了是NSCLC的主要確診工具外,還對其預(yù)后預(yù)測、隨訪的頻率有關(guān)。本研究表明術(shù)后放化療能顯著降低術(shù)后轉(zhuǎn)移的風(fēng)險(xiǎn),多個(gè)臨床研究同樣報(bào)道對復(fù)發(fā)風(fēng)險(xiǎn)較高的NSCLC患者而言,術(shù)后放化療能將殘留的癌細(xì)胞殺死,顯著提高手術(shù)的療效,避免術(shù)后復(fù)發(fā)和轉(zhuǎn)移[18-19]。
綜上所述,對NSCLC患者而言,胸腔鏡下肺葉切除手術(shù)的術(shù)后復(fù)發(fā)、轉(zhuǎn)移主要發(fā)生在同側(cè)肺部與骨,TNM分期、縱隔淋巴結(jié)轉(zhuǎn)移、分化程度、淋巴結(jié)轉(zhuǎn)移數(shù)目、術(shù)后放化療與術(shù)后復(fù)發(fā)、轉(zhuǎn)移有關(guān)。
[1]夏發(fā)明, 文石兵, 潘曉鋒, 等. 電視胸腔鏡輔助下小切口肺癌手術(shù)與開胸手術(shù)的對比研究[J]. 中國內(nèi)鏡雜志, 2012, 18(1):89-91.
[1]XIA F M, WEN S B, PAN X F, et al. Comparative study of videoassisted thoracoscope auxiliary small incision (VAMT) lobectomy with open thoracotomy for treatment of lung cancer[J]. China Journal of Endoscopy, 2012, 18(1): 89-91. Chinese
[2]SCOTT W J, ALLEN M S, DARLING G, et al.Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial[J]. J Thorac Cardiovasc Surg, 2010, 139(4): 976-981.
[3]MANY-ANE C H, CANAUD L, SOLOVEI L, et al. Video-assisted thoracoscopic lobectomy: an unavoidable trend? A retrospective single-institution series of 410 cases[J]. Interact Cardiovasc Thorac Surg, 2013, 17(1): 36-43.
[4]CHOI M S, PARK J S, KIM H K, et al. Analysis of 1067 cases of video-assisted thoracic surgery lobectomy[J]. Korean J Thorac Cardiovasc Surg, 2011, 44(2): 169-177.
[5]YAH T D, BLACK D, BANNON P G, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video·-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer[J].J Clin Oneol,2009,27(15):2553-2562.
[6]RUETH N M, ANDRADE R S. Is VATS lobectomy better:perioperatively, biologically and oncologically[J]. Ann Thorac Surg, 2010, 89(6): S2107-S2111.
[7]WHITSON B A, GROTH S S, DUVAL S J, et al. Surgery for earlystage non-small cell lung cancer: a systematic review of the videoassisted thoracoscopic surgery versus thoracotomy approaches to lobectomy[J]. Ann Thorac Surg, 2008, 86(6): 2008-2016.
[8]CHOI Y S, SHIM Y M, KIM K, et al. Pattern of recurrence after curative resection of local (stage I and II) non-small cell lung cancer: difference according to the histologic type[J]. J Korean Med Sci, 2004, 19(5): 674-676.
[9]KELSEY C R, MARKS L B, HOLLIS D, et al. Local recurrence after surgery for early stage lung cancer: an 11-year experience with 975 patients[J]. Cancer, 2009, 115(22): 5218-5227.
[10]VARLOTTO J M, RECHT A, FLICKINGER J C, et al. Factors associated with local and distant recurrence and survival in patients with resected nonsmall cell lung cancer[J]. Cancer, 2009,115(5): 1059-1069.
[11]FENG W, FU X L, CAI X W, et al. Patterns of local-regional failure in completely resected stage IIIA(N2) non-small cell lung cancer cases: implications for postoperative radiation therapy clinical target volume design[J]. Int J Radiat Oncol Biol Phys,2014, 88(5): 1100-1107.
[12]張真榕, 梁朝陽, 馮宏響, 等. 非小細(xì)胞肺癌根治術(shù)后生存分析[J]. 中華腫瘤防治雜志, 2016, 23(13): 872-878.
[12]ZHANG Z R, LIANG C Y, FENG H X, et al. Survival analysis after radical resection in non-small cell lung cancer patients[J].Chinese Journal of Cancer Prevention and Treatment, 2016,23(13): 872-878. Chinese
[13]National Lung Screening Trial Research Team. Reduced lungcancer mortality with low-dose computed tomographic screening[J]. N Engl J Med, 2011, 365(5): 395-409.
[14]楊廣愷, 楊元明. 系統(tǒng)性淋巴結(jié)清掃在非小細(xì)胞肺癌外科手術(shù)中的應(yīng)用分析[J]. 河南醫(yī)學(xué)研究, 2015, 24(7): 111-112.
[14]YANG G K, YANG Y M. Application of systematic lymph node dissection in surgical treatment of non-small cell lung cancer[J].Henan Medical Research, 2015, 24(7): 111-112. Chinese
[15]楊揚(yáng), 王啟, 劉延風(fēng), 等. 胸腔鏡與開胸手術(shù)對早期非小細(xì)胞肺癌患者生存率的比較[J]. 中國內(nèi)鏡雜志, 2015, 21(3): 225-229.
[15]YANG Y, WANG Q, LIU Y F, et al. Long-term survival comparison between lobectomy and video-assisted thoracic surgery thoracotomy for clinical stage I non-small-cell lung cancer patients[J]. China Journal of Endoscopy, 2015, 21(3): 225-229. Chinese
[16]徐新朝. 兩孔胸腔鏡肺葉切除及系統(tǒng)性淋巴結(jié)清掃手術(shù)治療肺癌的臨床效果[J]. 中國老年保健醫(yī)學(xué), 2016, 14(1): 95-97.
[16]XU X C. Clinical effect of two hole thoracoscopic lobectomy and systematic lymph node dissection in lung cancer[J]. Chinese Journal of Geriatric Care, 2016, 14(1): 95-97. Chinese
[17]滕洪生, 張志偉, 楊洋, 等. 胸腔鏡肺葉切除治療非小細(xì)胞肺癌的近遠(yuǎn)期療效及影響因素分析[J]. 重慶醫(yī)學(xué), 2014, 43(14):1764-1767.
[17]TENG H S, ZHANG Z W, YANG Y, et al. Short and long-term efficacy and influencing factors of thoracoscopic lobectomy for non-small cell lung cancer[J]. Chongqing Medicine, 2014,43(14): 1764-1767. Chinese
[18]胡思遠(yuǎn), 楊世疆, 薛亞軍, 等. 長春瑞濱聯(lián)合奧沙利鉑用于中期非小細(xì)胞肺癌術(shù)后輔助化療近期療效分析[J]. 中國醫(yī)藥導(dǎo)刊, 2010, 12(11): 1944-1945.
[18]HU S Y, YANG S J, XUE Y J, et al. An analysis of shortterm outcomes of postoperative chemotherapy by vinorelbine combined with oxaliplatin in patients with stage Ⅱ -Ⅲ a nonsmall cell lung cancer[J]. Chinese Journal of Medical Guide,2010, 12(11): 1944-1945. Chinese
[19]鄭遠(yuǎn)達(dá), 杜向慧. 中早期非小細(xì)胞肺癌術(shù)后輔助化療現(xiàn)狀和展望[J]. 中國腫瘤臨床, 2009, 36(5): 296-300.
[19]ZHENG Y D, DU X H. Postoperative adjuvant chemotherapy for non-small-cell lung cancer of early and middle stage[J]. Chinese Journal of Clinical Oncology, 2009, 36(5): 296-300. Chinese
Recurrence and metastasis in patients with non-small cell lung cancer after minimally invasive surgery
Meng Luo, Bo Liu, Di Liu, Jian Hu, Qian Long, Qing-bin Zhang, Hong Mei
(Department of Thoracic Surgery, Guizhou Provincial People's Hospital,Guiyang, Guizhou 550002, China)
ObjectiveTo analyze the recurrence and metastasis in patients with non-small cell lung cancer(NSCLC) after minimally invasive surgery.Methods123 patients with NSCLC underwent thoracoscopic lobectomy from January 2008 to December 2013 were enrolled in the study. Their perioperative data and follow-up results were analyzed, and postoperative recurrence and metastasis were recorded. Multivariate logistics regression analysis was performed to investigate the influencing factors of postoperative recurrence and metastasis.ResultsThe median operative time was 165 min (60 ~ 430 min) and the median intraoperative blood loss was 95 ml (20 ~ 3 100 ml).Postoperative complications occurred in 15 cases (12.2%). All patients were followed up regularly after discharge,and the median follow-up time was 23.5 months (6 ~ 69 months). During the follow-up period, postoperative recurrence and metastasis occurred in 36 cases (29.3%) and 42 cases (34.1%), including 16 cases (13.0%) patients simultaneously appeared recurrence and metastasis. The ipsilateral lung (52.8%) was the most common site of recurrence, followed by mediastinal lymph nodes (38.9%). Bone (28.6%) was the most common site of metastasis,followed by contralateral lung (26.2%) and brain (19.0%). Multivariate logistic regression analysis showed that stage II-III, mediastinal lymph node metastasis and low differentiation were independent risk factors of postoperative recurrence (P< 0.05) while stage Ⅱ ~ Ⅲ , number of lymph node metastasis ≥ 3, without postoperative radiotherapy and chemotherapy were independent risk factors of postoperative metastasis (P< 0.05).ConclusionsFor patients with NSCLC, recurrence and metastasis after thoracoscopic lobectomy occurred mainly in the ipsilateral lung and bone. TNM staging, mediastinal lymph node metastasis, differentiation degree, lymph node metastases, postoperative radiotherapy and chemotherapy were related with postoperative recurrence and metastasis.
thoracoscopic; non-small-cell lung cancer; recurrence; metastasis; factor analysis
R734.2
A
10.3969/j.issn.1007-1989.2017.09.008
1007-1989(2017)09-0042-06
2017-03-11
梅宏,E-mail:meihong1@21cn.com
羅猛和劉波為共同第一作者
(曾文軍 編輯)