【摘要】 目的 :识别纵隔淋巴结转移 (N2 )的非小细胞肺癌 (non smallcelllungcancer ,NSCLC)患者根治术后的预后不利因素 ,探讨N2 肺癌合理的手术适应证。方法 :回顾1993年 1月 1日～ 2 0 0 0年 1月 3 1日 ,2 12例根治性切除及系统性淋巴结廓清术后病理诊断为N2 肺癌患者的临床资料。应用Ka plan Meier法计算生存率 ,Log rank检验比较不同临床病理因素组间患者的生存差别 ;Cox多因素回归分析 ,判定N2 肺癌预后的不利因素。结果 :本研究 5年生存率为17% ,其中有N2 临床症状、大细胞肺癌和T4患者的预后最差 ,中位生存期不足 12个月。有纵隔淋巴结转移症状 (RR =9 2 ,P <0 0 0 1)、T4肿瘤 (RR =7 15 ,P <0 0 0 1)、淋巴结被膜受侵 (RR =1 72 8,P =0 0 0 8)和多站(≥ 3站 )淋巴结转移 (RR =2 2 94,P =0 0 0 2 )是预后的不利因素。结论 :N2 非小细胞肺癌患者的预后有很大的差别 ,根治切除的适应证应该加以选择。有明显纵隔淋巴结转移症状、大细胞肺癌和T4肿瘤的N2 患者预后极差 ,不宜将外科手术作为首选的治疗方法。更多还原

【Abstract】 OBJECTIVE:To identify the adverse prognostic factors of the patients with N2 (ipsilateral mediastinal lymph nodes metastasis) non-small cell lung carcinoma (NSCLC) and investigate the operative indication.METHODS:Clinical data of two hundred and twelve NSCLC patients with N 2 disease, who underwent radical surgery and systematic lymph node dissection from January 1993 to January 2000, were reviewed. Survival rates were calculated by Kaplan-Meier method and survival differences compared by Log-rank test. Cox regression analysis was performed to identify significantly adverse prognostic factors among the N 2 patients.RESULTS: The overall 5-year survival was 17%. The prognosis of the patients with clinical symptom of mediastinal lymph nodes metastasis, T 4 tumor and large cell carcinoma was worse, with the median survival less than one year. Multivariable analysis revealed 4 significantly adverse prognostic factors: with clinical symptom of N 2 disease(RR=9.2,P<0.001), T 4 tumor (RR=7.15,P<0.001), extra-capsular metastasis (RR= 1.728,P=0.008)and multiple diseased N 2 node (≥3 stations)(RR=2.294,P= 0.002).CONCLUSIONS:The prognosis of the patients with completely resected N 2 disease varies tremendously. The patients who are to be treated with surgery should be selected. Because of the poorer prognosis, in the patients with clinical symptom of N 2 disease, T 4 tumor and large cell carcinoma primary surgical treatment had better be abandoned.[更多还原