论文部分内容阅读
目的探讨巨块型肺癌的外科治疗及影响预后的因素。方法回顾性分析上海市肺科医院1992年8月至2005年8月经手术治疗的137例巨块型肺癌患者的临床及病理资料,其中根治性手术122例,姑息性手术15例。122例根治性手术中,肺叶切除63例,全肺切除48例,其他手术方式11例。分别对患者性别、肿瘤大小、p-TNM分期、局部淋巴结N分期、原发肿瘤T分期、组织学类型、手术方式和手术性质等因素进行预后分析。Kaplan-Meier计算生存率,Log rank法进行生存率显著性检验,应用Cox比例风险回归模型进行单因素和多因素分析。结果全组1、3、5年生存率分别为76.0%、49.2%和40.1%。单因素分析显示,患者性别(P=0.001)、p-TNM分期(P=0.001)、N分期(P=0.042)、T分期(P=0.006)、手术性质(P=0.026)是影响患者预后的因素。多因素分析则显示,p-TNM分期(P=0.001)是影响患者预后的独立因素。结论p-TNM分期是影响巨块型肺癌患者预后的主要因素。对巨块型肺癌患者,应严格控制手术适应证的选择,争取根治性手术,以获得较高的生存率。
Objective To investigate the surgical treatment of bulky lung cancer and its prognostic factors. Methods The clinical and pathological data of 137 giant lung cancer patients who underwent surgery in Shanghai Pulmonary Hospital from August 1992 to August 2005 were retrospectively analyzed. Among them, 122 were radical surgery and 15 were palliative surgery. In 122 cases of radical surgery, lobectomy was performed in 63 cases, pneumonectomy in 48 cases and other procedures in 11 cases. The prognosis of patients was analyzed by gender, tumor size, p-TNM stage, N-stage of local lymph nodes, T stage of primary tumor, histological type, operation method and surgical characteristics. Kaplan-Meier survival rate, Log rank test for survival was significant test, Cox proportional hazards regression model for univariate and multivariate analysis. Results The 1, 3, 5 year survival rates of the whole group were 76.0%, 49.2% and 40.1% respectively. Univariate analysis showed that patient’s sex (P = 0.001), p-TNM stage (P = 0.001), N stage (P = 0.042) and T stage (P = 0.006) the elements of. Multivariate analysis showed that p-TNM stage (P = 0.001) was an independent factor affecting the prognosis of patients. Conclusion The p-TNM stage is the main factor affecting the prognosis of patients with massive lung cancer. For bulky lung cancer patients, surgical indications should be strictly controlled choice for radical surgery, in order to obtain a higher survival rate.