【摘要】 目的探讨外科手术切除侵犯心脏、大血管和气管隆凸的T4期肺癌的预后和手术适应证。方法回顾性总结1988至2000年手术切除的151例T4期肺癌(心脏大血管成形术130例,隆凸成形术21例)病人资料,对可能影响其生存率的各种临床、病理、治疗等因素进行分析,并与同期112例手术切除的T3N1M0肺癌病人进行预后比较。结果全组无手术死亡病例,术后并发症发生率为43%。术后中位生存时间26.1个月,1年、3年、5年生存率分别为73.5%、33.1%和16.6%。单因素分析表明,病人预后与年龄、肺切除范围、有无淋巴结转移、是否根治性切除及是否行新辅助化疗有关(P<0.05)。多因素分析结果表明,肺切除范围、有无淋巴结转移、是否根治性切除是影响总生存率的独立预后因素(P<0.05)。T4N0M0与同期T3N1M0病人5年生存率分别为38.6%、16.1%,两组比较差异有统计学意义(P=0.0383),而术后并发症发生率差异无统计学意义(P>0.05)。结论对于侵犯心脏、大血管和隆凸的T4期肺癌,正确选择病例和良好的手术技术确保完整切除局部肿瘤,也能取得较满意的临床疗效。尤其是对以局部浸润为主而无淋巴结转移的T4期肺癌,手术疗效优于有淋巴结转移的T3期肺癌。新辅助化疗有助于延长术后生存期。更多还原

【Abstract】 Objective To identify clinical prognostic predicators and surgery indicator of stage IIIb-T₄ in patients with lung cancer patients whose tumor invaded heart, main vessel or carina. Methods From 1988 to 2000,151 patients with pathological stage IIIb-T₄ lung cancer who underwent resection by Shandong Provincial Hospital were analyzed as control samples, 112 patients with pathological stage IIIa-T₃N₁M₀ who underwent resection at the same time were also analyzed. Factors were estimated from the date of operation using the Kaplan-Meier and Log rank analysis. The Cox regression model evaluated the influence of factors on the survival. Results The median survival period were 26.1 months and the overall of 1-year, 3-year and 5-year survivals of the 151 patients were 73.5%, 33.1% and 16.6% respectively.The significant prognostic factors （P<0.05） demonstrated by univariate analysis included age, the area of lung resection, lymph node metastasis, margin, neoadjuvant chemotherapy, while the area of lung resection, margin, lymph node metastasis served as the independent prognostic factors （P<0.05） with multivariate analysis. There was a significant difference in postoperative 5-year survival between stage T₄N₀M₀ and T₃N₁M₀ （P<0.05）. Conclusion Satisfying results could be achieved by strictly selecting cases and skilled surgical technique for some T₄ lung cancer, especially those without lymph node metastasis. Neoadjuvant chemotherapy helped to prolong the postoperative survival.更多还原