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目的探讨Ⅲａ（Ｎ２）期非小细胞肺癌（ｎｏｎ－ｓｍａｌｃｅｌｌｕｎｇｃａｎｃｅｒ，ＮＳＣＬＣ）是否需要手术治疗。材料与方法所有病人均经临床或病理确诊为ⅢａＮ２期。手术治疗组为接受根治性手术及术后予根治性常规分割放疗无术前放疗史者，共７１例。术后放疗剂量中位值为５９（５０～７０）Ｇｙ／３１（２４～３８）次，４６（３３～６３）天。无手术组８６例，其中采用非常规放疗（超分割或加速超分割）５６例，常规放疗组３０例。临床肿瘤灶放射剂量：加速超分割组７２～７６Ｇｙ／６６～６９次，３３（２９～４８）天，超分割组６９．８±２．１Ｇｙ／５６～６２次，４２～５０天，常规放疗组６２～６５Ｇｙ／３２～３６次，４８（４５～５２）天。结果手术组，非常规分割放疗组及常规放疗组２年生存率分别为４６％，４４％，２２％（Ｐ＝０．０３２）；２年局控率为６６％，５２％，２０％（Ｐ＜０．００１）；２年远处转移率为４８％，３４％，３５％（Ｐ＝０．３４９）。经Ｃｏｘ多因素分析在生存及局控上手术参与组及非常规分割放疗组均较常规放疗组疗效高（Ｐ＝０．０３５，Ｐ＜０．００１），而远处转移３组无差异（Ｐ＝０．４５３）。结论对于即使技术上能行手术切除Ⅲａ（Ｎ２）期?
Objective To investigate whether surgery for stage IIIa (N2) non-smal cell lung cancer (NSCLC) requires surgery. Materials and Methods All patients were clinically or pathologically diagnosed as stage IIIaN2. The surgical treatment group consisted of 71 patients who underwent radical surgery and postoperative radical conventional fractionated radiotherapy with no history of preoperative radiotherapy. The median dose of postoperative radiotherapy was 59 (50-70) Gy/31 (24-38) and 46 (33-63) days. There were 86 patients without surgery, of which 56 patients received unconventional radiotherapy (hyperfractionation or accelerated hyperfractionation) and 30 patients received conventional radiotherapy. Clinical tumor focus radiation dose: Accelerated hyperfractionation group 72-76Gy/66-69 times, 33 (29-48) days, ultra-segmented group 69.8±2.1Gy/56-62 times, 42-50 days, conventional radiotherapy Group 62 to 65 Gy/32 to 36 times, 48 (45 to 52) days. Results The 2-year survival rates of the surgical group, the unconventional fractionated radiotherapy group and the conventional radiotherapy group were 46%, 44%, and 22%, respectively (P=0.032). The 2-year control rates were 66%, 52%, and 20% ( P<0.001); 2-year distant metastasis rate was 48%, 34%, 35% (P=0.349). Cox multivariate analysis showed that the surgical intervention group and the unconventional fractionated radiotherapy group had higher efficacy than the conventional radiotherapy group in survival and localization (P=0.035, P<0.001), but there was no difference in the distant metastasis group ( P=0.453). Conclusions Even surgically resected stage IIIa (N2) is technically feasible?