【摘要】 目的　研究非小细胞肺癌 (NSCLC)新辅助化疗的临床病理学改变及其与临床疗效评价的一致性 ,探讨NSCLC新辅助化疗的临床应用价值。方法　 84例Ⅰ～Ⅲ期NSCLC患者随机分为综合治疗组和单纯手术组各 42例。综合治疗组术前行MVP方案化疗 2周期 ,分别进行临床评价和病理学评价 ,术后继续化疗 2～ 4周期 ;单纯手术组仅行手术治疗。结果　综合治疗组原发灶的肿瘤细胞在镜下显示不同程度的变性和坏死 ,单纯手术组则无此改变。术前新辅助化疗临床评价和病理学评价有效率均为 5 9.5 % (2 5 /4 2 )。两种评价的一致率为 71.4% (30 /4 2 ,Kappa值 =0 .40 7,P <0 .0 1)。综合治疗组与单纯手术组比较 ,总生存率差异有显著性 (P =0 .0 47) ,经分层分析 ,两组Ⅰ～Ⅱ期患者生存率差异无显著性 (P >0 .0 5 ) ,但Ⅲ期患者生存率差异有显著性 (P =0 .0 37)。结论　伴有纤维化的变性和坏死是原发灶化疗后的主要病理学改变形式。化疗疗效的临床评价能够反映病理学变化。对Ⅲ期NSCLC患者行术前和术后辅助化疗与单纯手术相比有更好的治疗效果更多还原

【Abstract】 Objective To explore the clinicopathological changes of non small cell lung cancer tissues after neoadjuvant chemotherapy with MVP (MMC+VDS+DDP) regimen and its concordance with clinical evaluation, and to study the clinical value of neoadjuvant chemotherapy. Methods A total of 84 patients with NSCLC were randomized into combinated therapy group (42 cases) and surgical group (42 cases). The combinated therapy group were given MVP regimen for 2 cycles before operation and 2 4 cycles after operation, however, the surgical group only received surgical treatment. The efficacy of preoperative chemotherapy were determined by pathologic examination under light microscope and electron microscope and clinical evaluation. Results Combinated therapy group showed various degrees of degeneration and necrosis of tumor cells, which was not found in surgical group. The overall response rate of neoadjuvant chemotherapy was 59.5% (25/42) by both pathological and clinical evaluation. The coincidence ratio of the two evaluation methods was 71.4% (Kappa value=0.407,P<0.01). Between the two groups, there was a significant difference in total survival rate (P=0.047). And further analysis showed that survival rate was remarkably different in patients with stage Ⅲ between the two groups (P=0.037), but not in those with stage Ⅰ and Ⅱ (P>0.05). Conclusion Degeneration and necrosis with fibrosis are the main pathological phenotypes of the primary lesion after induction chemotherapy, which can be showed by clinical evaluation to chemotherapy efficacy. The preoperative and postoperative adjuvant chemotherapy may be benefical to patients with stage Ⅲ NSCLC.更多还原