论文部分内容阅读
目的:探讨新辅助化疗（NCT）对ⅢA-N2期非小细胞肺癌（NSCLC）患者淋巴结转移率（LNR）的影响，以及分析LNR与预后的关系。方法:回顾性收集2013年1月至2018年12月河北北方学院附属第一医院胸心外科128例ⅢA-N2期NSCLC患者的资料，按治疗方式分两组，观察组（64例）进行NCT+手术治疗，对照组（64例）直接手术治疗。观察两组患者淋巴结转移情况和生存情况。根据LNR和N2淋巴结状态分亚组，进行亚组生存分析。并对观察组进行单因素和多因素分析。结果:观察组在转移淋巴结数量、淋巴结阳性患者率和LNR均低于对照组，分别为3.8±2.1比4.9±2.4、92.2%比100%、19.1%比22.4%（均n P<0.05）；观察组无进展生存期（PFS）和总生存期（OS）优于对照组（均n P<0.05）。观察组和对照组低LNR亚组均比高LNR亚组具有更好的PFS和OS（均n P<0.05）。观察组非多站N2淋巴结转移者具有更好的PFS和OS（均n P<0.05）。观察组单因素分析显示低LNR患者具有更好的2年PFS和OS（均n P<0.05）；多因素分析显示：LNR越高，死亡（n HR=2.178，95%n CI： 1.025~4.626，n P=0.043）和进展（n HR=2.130，95%n CI： 1.123~4.038，n P=0.021）的风险越大。n 结论:NCT能够改善ⅢA-N2期NSCLC患者的预后和降低LNR，LNR有望可能作为评估预后的指标。“,”Objective:To investigate the effect of neoadjuvant chemotherapy (NCT) on the lymph node ratio (LNR) of patients with stage ⅢA-N2 non-small cell lung cancer (NSCLC), and analyze the relationship between LNR and prognosis.Methods:The data of 128 patients with stage ⅢA-N2 NSCLC admitted to the Department of Cardiothoracic Surgery of the First Affiliated Hospital of Hebei North University from January 2013 to December 2018 were retrospectively collected. The patients were divided into two groups according to the treatment method. The patients in the observation group (64 cases) were treated with NCT and surgery, and the patients in the control group (64 cases) were treated with surgery. Lymph node metastasis and survival were observed in the two groups. Subgroups were divided according to LNR and N2 lymph node status, and survival analysis was performed for each subgroup. Univariate and multivariate analysis were conducted for the observation group.Results:The number of metastatic lymph nodes, the proportion of patients with positive lymph nodes, and the rate of lymph node metastasis in the observation group were lower than those in the control group,3.8±2.1 vs 4.9±2.4,92.2% vs 100%,19.1% vs 22.4% respectively (all n P<0.05). Progression-free survival (PFS) and overall survival (OS) in the observation group were better than those in the control group (bothn P<0.05). Both the observation and control subgroups with low LNR had better PFS and OS than the subgroups with high LNR (bothn P<0.05). Patients in the observation group with non-multi-site N2 lymph node metastasis had better PFS and OS (bothn P<0.05). Univariate analysis of observation group showed that patients with low LNR had better 2-year PFS and OS(bothn P<0.05). Multivariate analysis showed that the higher the LNR, the greater the risk of death (n HR=2.178,95%n CI: 1.025-4.626,n P=0.043) and progression (n HR=2.130,95%n CI: 1.123-4.038,n P=0.021).n Conclusion:NTC could improve the prognosis and reduce LNR of patients with stage ⅢA-N2 NSCLC, and LNR was expected to be a prognostic indicator.