论文部分内容阅读
目的:探讨Ⅲn A／Nn 2期非小细胞肺癌（NSCLC）患者淋巴结转移率与预后的相关性。n 方法:回顾性分析2012年1月至2015年6月于山西省肿瘤医院接受手术治疗的350例Ⅲn A／Nn 2期NSCLC患者的临床资料。采用Cox风险回归模型确定淋巴结转移率最佳截断值，依此截断值分为高淋巴结转移率组和低淋巴结转移率组。分析临床病理特征与淋巴结转移率的关系，采用Cox回归模型分析预后危险因素，用Kaplan-Meier法分析高、低淋巴结转移率组患者总生存（OS）和无病生存（DFS）情况。n 结果:淋巴结转移率最佳截断值为0.2。高淋巴结转移率（>0.2）组180例，低淋巴结转移率（≤0.2）组170例。高淋巴结转移率组腺癌、最高淋巴结转移患者比例均高于低淋巴结转移率组[72.2%（130／180）比52.9%（90／170），52.8%（95／180）比29.4%（50／170），均n P<0.05]。高淋巴结转移率组跳跃性Nn 2淋巴结转移、Nn 2淋巴结单站转移和最高组Nn 2淋巴结单站转移患者比例均低于低淋巴结转移率组[51.1%（92／180）比71.8%（122／170），25.0%（45／180）比44.1%（75／170），38.9%（70／180）比75.3%（128／175），均n P<0.05]。Cox多因素回归模型分析显示，腺癌、多站Nn 2淋巴结转移、淋巴结转移率是Ⅲn A／Nn 2期NSCLC患者DFS的独立危险因素（n HR＝2.201，95%n CI 1.444～3.355；n HR＝2.971，95%n CI 1.950～4.529；n HR＝3.543，95%n CI 1.874～6.699；均n P<0.05）；淋巴结转移率是Ⅲn A／Nn 2期NSCLC患者OS的独立危险因素（n HR＝3.669，95%n CI 1.941～6.938，n P<0.05）。低淋巴结转移率组5年OS率（64.00%）高于高淋巴结转移率组（36.58%）（n χ2＝11.422，n P＝0.001），低淋巴结转移率组5年PFS率（45.00%）高于高淋巴结转移率组（18.32%）（n χ2＝13.624，n P0.2) and 170 cases with low lymph node metastasis rate (≤0.2). The proportion of the patients with adenocarcinoma and the highest lymph node metastasis in the high lymph node metastasis rate group was higher than that in the low lymph node metastasis rate group [72.2% (130/180) vs. 52.9% (90/170), 52.8% (95/180) vs. 29.4% (50/170), alln P<0.05]. The proportion of patients with jumping Nn 2 lymph node metastasis, single station Nn 2 lymph node metastasis and single station Nn 2 lymph node metastasis in the highest group was lower than that in the low lymph node metastasis rate group [51.1% (92/180) vs. 71.8% (122/170), 25.0% (45/180) vs. 44.1% (75/170), 38.9% (70/180) vs. 75.3% (128/175), all n P<0.05]. Cox multi-factor regression model analysis showed that adenocarcinoma, multiple stations Nn 2 lymph node metastasis, lymph node metastasis rate were independent risk factors of DFS for NSCLC patients with stage Ⅲn A/Nn 2 (n HR = 2.201, 95% n CI 1.444-3.355; n HR=2.971,95% n CI 1.950-4.529; n HR=3.543, 95% n CI 1.874-6.699; all n P<0.05). Lymph node metastasis rate was an independent risk factor of OS for NSCLC patients with stage Ⅲn A/Nn 2 (n HR = 3.669, 95% n CI 1.941-6.938, n P<0.05). The 5-year OS rate of the low lymph node metastasis rate group was higher than that of the high lymph node metastasis rate group (64.00% vs. 36.58%,n χ2 = 11.422, n P = 0.001). The 5-year DFS rate in the low lymph node metastasis rate group was higher than that in the high lymph node metastasis rate group (45.00% vs.18.32%, n χ2 = 13.624, n P<0.01).n Conclusion:Lymph node metastasis rate is an independent influencing factor for the prognosis of NSCLC patients with Ⅲn A/Nn 2 stage, and it can effectively evaluate the prognosis.n