【摘要】 目的:局部晚期非小细胞肺癌(locally advanced non-small cell lung cancer,LANSCLC)放化综合治疗已是共识,手术介入是否致临床获益报道不一,本研究目的是评价手术治疗在综合治疗中的作用。方法:将71例患者据治疗方法分为A组:手术+放化疗组(37例)、B组:放疗+化疗组(34例)。采用Kaplan-Meier和Log-Rank方法进行生存分析,RTOG标准评价急性反应和晚期损伤。结果:中位随访25.5个月,A组中位总生存时间34.6个月,中位无进展生存时间22.3个月,1、2、3年生存率分别为95%、78%、34%;B组近期有效率52.9%,中位总生存时间为16.5个月,1、2、3年生存率分别为76%、28%、10%。A组在生存时间及生存率方面均有明显优势(P<0.05)。化疗不良反应两组相较差异无显著性(P>0.05)。放疗主要不良反应为放射性食管炎及放射性肺炎。手术并未明显增加放疗不良反应发生率及发生程度(P>0.05)。术后患者半数以上2年内出现疾病进展,疾病进展原因主要为远处转移,转移率76.2%。结论:LANSCLC治疗要以综合治疗为主,手术治疗可使生存受益,并延长无进展生存时间以及生存时间,并未增加放化疗不良反应。更多还原

【Abstract】 Objective:To evaluate the effects of surgery in combined modality therapy for locally advanced non-small cell lung cancer(LANSCLC).Methods:Total of 71 cases were divided into two groups:in group A,37 patients received operation plus chemoradiotherapy,in group B,34 patients received chemoradiotherapy.The Kaplan-Meier method was used to calculate the overall survival rate.Acute and late toxicities were graded according to RTOG radiation morbidity scoring criteria.Results: With a median followed-up of 25.5months,in group A,the median overall survival time was 34.6 months,the median progression-free survival time(PFS)was 22.3months,and the 1-,2-,3-year overall survival rates were 95%,78% and 34% respectively.In group B,the response rate(CR plus PR) was 52.9%,the median overall survival time was 16.5 months,and the 1-,2-,3-year survival rates were 76%,28% and 10%.Both OS and OSR in group A have advantage(P<0.05).The major toxicity of radiotherapy were radioactive esophagitis and pneumonia.To the toxicity of chemotherapy in two group,there was no significant difference(P>0.05).No more than half of patients in group B occurred progression in 2 years.The main reason of progression in group A and B was distant metastasis.The metastatic rate was 76.2%.Conclusion:Survival benefit from surgical treatment can improve survival and prolong progression-free survival time and survival time,and did not increase the toxicity of radiotherapy and chemotherapy.更多还原