Outcome and Prognostic Factors Associated with Resectable Stage IIIA N2 Non-Small Cell Lung Cancer

可手術切除的IIIAN2非小細胞肺癌的預後及影響因子

盧俊安(Chun-An Lu) ； 陳志弘(Chih-Hung Chen) ； 吳怡成(Yi-Cheng Wu) ； 劉會平(Hui-Ping Liu) ； 蔡熒煌(Ying-Huang Tsai)

《胸腔醫學》 20卷6期 (2005/12) Pp. 541-547

https://doi.org/10.29806/TM.200512.0005

摘要

背景：可切除的IIIAN2非小細胞肺癌預後通常是不好的，主要的原因是術後有很高的復發機率。本研究的目的是探討術後IIIAN2非小細胞肺癌的預後及影響因子，並期望這些發現能提供進一步的臨床策略及研究。
方法：我們回溯性地納入西元1999年至2003年5年期間的非小細胞肺癌，在醫院接受完全手術治療，並最後病理報告證實同側縱膈腔有林巴結轉移的病人。我們記錄病人的臨床及腫瘤特徵和預後。最後再以統計學加以分析這些病人的預後及其影響因子。
結果：共有54位病人收案。32為是男性，22位是女性。非小細胞肺癌術後復發時間的中位數為20.4個月；存活中位數為287個月。只有同側縱膈腔淋巴結的轉移個數和預後有相關(p=0.02)，而多個淋巴結轉移造成死亡的相對危險性是單個淋巴結轉移的32倍。
結論：IIIAN2的存活率是令人失望的。縱膈腔淋巴結轉移個數是影響預後的因子；若病人有多個縱膈腔淋巴結轉移的預後就比較不好。

關鍵字

IIIA ； N2 ； 淋巴結轉移

並列摘要

Background and Purpose: The outcomes of patients with stage IIIA ipsilateral mediastinal lymph node (N2) metastasized resectable non-small cell lung cancer (NSCLC) are poor due to the higher recurrence rate after operation. The purpose of this study was to evaluate the prognostic factors associated with survival in patients with stage IIIA N2 NSCLC who have undergone complete surgical resection. These findings may be useful in clinical strategy and for further study.
Methods: From Jan 1999 through December 2003, we retrospectively reviewed the records of patients with stage IIIA NSCLC who had undergone complete resection and were found to have positive N2 lymph node metastasis in the final pathology. We recorded the patient's clinical and tumor characteristics, recurrence sites, and survival. The outcomes after surgical resection were statistically analyzed.
Results: Fifty-four patients were enrolled for analysis. There were 32 (59.3%) males and 22 (40.7%) females. The median age was 63 years (range, 39-77). The median follow-up time for all patients was 20.4 months. The median disease-free time and survival time were 24.7 months and 28.7 months, respectively. Adjuvant radiotherapy did not have a significant beneficial effect on survival. The recurrence rate was 57.4% and distant metastasis was the major cause. The most frequent site of distant metastasis was the bone. Only the independent factor of the number of N2 metastases had a significant impact on survival (p=0.02), and the hazard ratio of multiple N2 to single N2 metastasis was 3.2. Other factors, including gender, age older than 65 years or not, visceral pleural invasion, and a tumor size larger than 3 cm or not, did not have a significant effect on survival.
Conclusions: The survival of patients with stage IIIA N2 NSCLC was unsatisfactory. The independent factor of the number of N2 metastases had a significant effect on survival, and the prognosis of patients with multiple N2 metastases was poor, compared to patients with single N2 metastasis.

並列關鍵字

IIIA ； N2 ； non-small cell lung cancer ； lymph node metastasis