可手术非小细胞肺癌的预后因素分析

目的:探讨术前、术后辅助化疗的Ⅱ、Ⅲ期非小细胞肺癌手术患者的多种预后因素。方法:对1995年1月～2002年9月65例围手术期化疗非小细胞肺癌患者的临床、病理资料进行回顾性研究,用Kaplan-Meier曲线、生命表法及Log-Rank法检验生存率差异,用Cox单、多因素分析评价各因素对预后的影响。结果:65例非小细胞肺癌的1、3、5年生存率分别为84.13%、37.88%和10.18%。单因素分析显示综合分期、手术根治情况、术后化疗周期数、肿瘤侵犯情况、胸内淋巴结、肿瘤单径大小、肺门情况、出血量、术后首次化疗距手术时间明显影响生存;Cox多因素分析中,肿瘤单径大小及术后化疗周期数为影响预后的独立因素。结论:肿瘤单径大小及术后化疗周期数是影响Ⅱ、Ⅲ期非小细胞肺癌预后的重要因素。     

288例手术切除的IIIA-N2非小细胞肺癌患者的生存分析

背景与目的探讨完整切除术后IIIA期非小细胞肺癌(Non-small cell lung cancer,NSCLC)的床预后因素。方法对1999年1月至2004年12月中山大学肿瘤防治中心收治288例手术切除的IIIA期非小细胞肺癌患者进行生存分析,生存率的计算及单因素生存分析用Kaplan-Meier法,Log-rank法检验;Cox比例风险模型进行多因素分析。结果288例手术切除的IIIA期非小细胞肺癌患者的中位生存期为770天,1年、2年、3年、4年和5年的累计生存率分别为77.1%、52.4%、34.9%、28.1%和20.2%。单因素生存分析发现年龄(<60岁vs≥60岁)、是否吸烟、手术方式、T分期、术后化疗、术后化疗疗程数、术后放疗7个临床因素与IIIA期NSCLC患者术后的预后有统计学意义,进一步利用Cox比例风险模型进行多因素分析发现术后化疗、术后放疗、T分期是影响预后的独立因素。结论术后化疗、术后放疗、T分期是影响IIIA期非小细胞肺癌预后的重要因素。     

87例小细胞肺癌多因素生存分析

目的 分析小细胞肺癌患者预后的影响因素.方法 收集87例经组织病理学或细胞学确诊的小细胞肺癌,分析性别、年龄、分期、血红蛋白水平、乳酸脱氢酶水平、一线化疗疗效、放疗及手术治疗等因素与患者生存期的关系,采用Kaplan-Meier法生存分析,进行Log-rank非参数检验,用COX比例风险模型进行多因素生存分析.结果 全组患者12、24和36个月生存率分别为78.2%、37.9%和8.0%,其中局限期12、24和36个月生存率分别为85.7%、42.9%和10.7%,广泛期12、24和36个月生存率分别为64.5%、29.O%和3.2%.全组中位生存时间为18个月,其中局限期生存时间19个月,广泛期生存时间14个月.单因素分析发现分期、血红蛋白水平、乳酸脱氢酶水平、一线化疗疗效、放疗及手术治疗均可影响患者的生存期,多因素分析则提示分期、一线化疗疗效、放疗及手术治疗是患者生存的独立影响因素.结论 分期、化疗疗效、是否接受放疗及手术治疗可能是影响小细胞肺癌患者预后的主要因素.     

术后辅助放疗对ⅢA-N2期非小细胞肺癌的疗效探讨

目的 探讨术后辅助放疗对ⅢA-N2期非小细胞肺癌的疗效.方法 136例经病理学检查确诊为ⅢA-N2期的非小细胞肺癌患者,均行根治性手术及术后辅助化疗,辅助化疗后75例观察(A组),61例行辅助放疗(B组).结果 A组、B组1年总生存率分别为90.7%和98.4%,3年总生存率分别为41.2%和48.7%,5年总生存率分别为30.8%和33.7%(P=0.039).A组、B组1年无复发生存率分别为87.7%和95.1%,3年无复发生存率分别为59.9%和73.1%,5年无复发生存率分别为47.9%和65.8%(P=0.040).单因素生存分析提示:吸烟、临床N2期、T分期、阳性淋巴结个数、阳性淋巴结比例、N2淋巴结累及区域、辅助化疗疗程、行术后辅助放疗为预后因素.多因素生存分析提示:临床N2期、T分期、阳性淋巴结个数、行术后辅助放疗为独立预后因素.结论 ⅢA-N2期非小细胞肺癌中,术前临床诊断为N2期、T分期越晚、手术切除阳性淋巴结个数越多,预后越差;行术后放疗可提高局控率,延长总生存时间.     

288例手术切除的ⅢA-N2非小细胞肺癌患者的生存分析

背景与目的 探讨完整切除术后ⅢA期非小细胞肺癌(Non-small cell lung cancer,NSCLC)的床预后因素.方法 对1999年1月至2004年12月中山大学肿瘤防治中心收治288例手术切除的ⅢA期非小细胞肺癌患者进行生存分析,生存率的计算及单因素生存分析用Kaplan-Meier法,Log-rank法检验;Cox比例风险模型进行多因素分析.结果 288例手术切除的ⅢA期非小细胞肺癌患者的中位生存期为770天,1年、2年、3年、4年和5年的累计生存率分别为77.1%、52.4%、34.9%、28.1%和20.2%.单因素生存分析发现年龄(<60岁vs≥60岁)、是否吸烟、手术方式、T分期、术后化疗、术后化疗疗程数、术后放疗7个临床因素与ⅢA期NSCLC患者术后的预后有统计学意义,进一步利用Cox比例风险模型进行多因素分析发现术后化疗、术后放疗、T分期是影响预后的独立因素.结论 术后化疗、术后放疗、T分期是影响ⅢA期非小细胞肺癌预后的重要因素.     

467例小细胞肺癌患者的预后分析

目的:肺癌发病率逐年上升,死亡率居癌症之首,其中小细胞肺癌恶性程度最高.本研究旨在分析小细胞肺癌的独立预后因素.方法:回顾性分析解放军总医院2005年1月至2009年12月经组织病理或细胞学确诊的467例小细胞肺癌患者,对可能影响其预后的相关因素进行单因素和多因素分析.结果:局限期患者1、2、3年生存率分别为81.72%、54.95%、41.09%,中位生存时间为27个月.广泛期患者1、2、3年生存率分别为66.81%、25.77%、17.06%,中位生存时间为17个月.单因素分析显示年龄、临床分期、是否肝转移、是否手术、化疗、放疗、一线化疗疗效、一线化疗周期数、初治时血红蛋白水平、LDH值、NSE值及CY-FRA21-1值与患者预后相关(P<0.05).多因素分析显示是否放疗、总周期数、一线化疗疗效和CYFRA21-1对患者的生存时间有显著影响.结论:是否放疗、化疗总周期数、一线化疗疗效和初治时CYFRA21-1水平是影响小细胞肺癌的独立预后因素.     

睾丸恶性淋巴瘤26例临床分析

目的:睾丸恶性淋巴瘤临床较为少见,本文总结了该病的临床特点、诊断、治疗方法及其预后.方法:26例睾丸恶性淋巴瘤,原发22例(84.6%),继发4例(15.4%),所有患者均接受睾丸手术切除治疗,病理诊断明确.原发睾丸恶性淋巴瘤息者中可随访的为19例,其中3例仅接受手术治疗,14例接受了手术和化疗,2例患者接受了手术联合化疗和放疗.4例继发患者均接受了局部放疗和全身化疗.结果:全组原发患者的中位年龄57岁,首发症状均为无痛性睾丸肿大,主要病理类型为弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL),占84.6%(22/26),少见病理类型包括NK/T细胞淋巴瘤、淋巴母细胞淋巴瘤和B细胞不能分型者.所有原发患者的5年生存率为72%,Ann-Arbor分期Ⅰ～Ⅱ期患者的中位生存时间(median Burvival time,MST)为95.8个月,Ⅲ～Ⅳ期的MST时间为21.5个月.接受手术和化疗的患者的中位复发和MST分别为78.8和92.3个月.继发患者的中位复发时间为7.5个月,MST为25.0个月.结论:睾丸恶性淋巴瘤好发于老年男性,其预后可能与临床分期、病理类型和治疗方法有关.建议对所有患者在手术后进行放疗,并给予4～6个疗程的CHOP/CHOPlike方案化疗.     

原发性食管小细胞癌47例预后分析

目的:探讨局限期原发性食管小细胞癌的治疗和预后.方法:回顾性分析1989年5月-2006年3月期间在本院接受手术治疗的47例原发性食管小细胞癌的临床资料.结果:47例患者均接受了手术治疗,其中部分患者还接受了术后化疗和(或)放疗,全组患者的中位生存时间为10.3个月,1、3、5年的生存率分别为42.2%、12.1%和4.6%.单纯手术组的中位生存时间为8.2个月,术后化疗组和术后联合放、化疗组的预后要优于单纯手术组(P=0.000和P=0.038),单纯手术组与术后放疗组的生存比较差异无统计学意义(P=0.081).多因素分析显示临床分期是影响患者预后的主要因素(P=0.003).结论:手术联合放、化疗或化疗是治疗局限期原发性食管小细胞癌的主要手段,有助于延长患者的生存期.     

57例不可手术的Ⅲ期非小细胞肺癌的治疗及生存分析

目的分析不可手术的Ⅲ期非小细胞肺癌的治疗方法及其对预后的影响。方法57例ⅢB期及ⅢA期不可手术切除的非小细胞肺癌患者,其中36例(ⅢA期9例,ⅢB期27例)行静脉化疗加胸部放疗(A组),21例(ⅢA期5例,ⅢB期16例)行支气管动脉灌注联合静脉化疗加胸部放疗(B组)。结果A、B组的中位无进展生存时间(TTP)分别为12.0和11.75个月(P=0.74);中位生存期(MST)分别为17.96及18.33个月(P=0.461),1,2,3年生存率分别为75.0%、29.1%、11.7%及76.2%、23.8%、4.8%,两组之间比较差异无显著性(均为P>0.05)。结论在静脉化疗联合胸部放疗的基础上合并支气管动脉灌注化疗,并不能显著性改善不可手术的Ⅲ期非小细胞肺癌患者的远期生存。     

259例胸腺瘤术后放疗长期生存结果及预后因素分析

目的回顾性分析259例胸腺瘤治疗结果，试图获得影响胸腺瘤术后放疗长期生存的预后因素。方法267例中符合入组条件的胸腺瘤共259例进入研究，其中男166例，女93例，中位年龄45岁。Masaoka分期Ⅰ期55例，Ⅱ期56例，Ⅲ期131例，Ⅳ期17例。手术完全切除179例，不完全切除62例，仅做活检18例。259例术后常规放疗的中位剂量为4939cGy（2148～6691cGy）。72例在不同时期接受了环磷酰胺、阿霉素、顺铂，氟尿嘧啶、长春新碱等的化疗。用Kaplan-Meier法计算总生存率、肿瘤特异性生存率、无瘤生存率和局部控制率。Cox回归比例风险模型用于影响预后的多因素分析。结果全组5、10年总生存率分别为81％、69％。5、10年肿瘤特异性生存率分别为82％、72％。5、10年无瘤生存率分别为74％、60％。5、10年局部控制率分别为82％、73％。Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年总生存率分别为94％、85％、74％、36％，10年总生存率分别为85％、61％、49％和24％。多因素分析显示Masaoka分期、手术切除的完全性、肿瘤包膜有无侵犯和性别是影响长期生存的独立预后因素。结论全组5、10年总生存率较高，Masaoka分期、手术切除的完全性、肿瘤包膜有无侵犯是影响胸腺瘤手术后放疗预后的主要因素。     

不可切除Ⅲ A(N2)期非小细胞肺癌的术前化疗

目的探讨不能切除的ⅢA（N2）期非小细胞肺癌（NSCLC）的治疗方法。方法1999年1月至2002年12月,76例不可切除ⅢA（N2）期NSCLC患者接受诺维苯（NVB,25mg／m^23,第1,5天）加卡铂（300mg／m^2,第1天）2个周期的化疗,第二周期化疗后3周重新评估能否手术切除。对化疗效果达到部分有效（PR）或完全有效（CR）、估计能完全切除的64例患者行剖胸探查术;对化疗后评价为稳定（SD）和进展（PD）的12例患者行放疗。64例手术患者中,完全切除（肺叶或全肺切除加纵隔淋巴结清扫术,至少达到R3水平）56例,术后继续给予诺维苯加卡铂化疗2个周期;不完全切除8例,另加局部放疗。结果76例不可切除的ⅢA（N2）期NSCLC经诱导化疗后手术或放疗,中位生存期为18．6个月,1,2,3年生存率分别为64．2％、39．4％和25．6％。其中完全切除患者的中位生存期为28．2个月,1,2,3年生存率分别为70．4％、52．5％和38．6％。结论对不可切除的局部晚期NSCLC,如诱导化疗后可以手术,应首选外科治疗。     

153例经外科干预的非小细胞肺癌伴胸膜播散患者的预后研究

  目的  探讨经不同外科治疗方式干预的非小细胞肺癌（non-small cell lung cancer,NSCLC）伴胸膜播散患者的预后。  方法  回顾性分析2002年5月至2011年5月153例在中国医学科学院肿瘤医院胸外科接受外科手术并于术中或术后确诊NSCLC伴胸膜播散患者的临床资料。  结果  全组患者,3年和5年生存率分别为38.5%和24.2%,中位生存时间29.0个月。其中31例接受胸膜结节活检术,122例接受原发肿瘤切除术,两组患者5年生存率分别是16.1%和26.2%,中位总生存时间分别为24.0个和29.0个月,两组间生存差异均无统计学意义（P>0.05）。122例接受原发肿瘤切除术患者中,是否行淋巴结清扫和转移结节切除,以及行部分肺叶或肺叶切除对患者预后影响无显著性差异（P>0.05）。  结论  NSCLC伴胸膜播散患者预后较差,行不同外科干预方式生存未显示出显著性差异,外科干预的主要作用是除外及证实胸膜播散以明确病理诊断,指导后续治疗,肿瘤切除应慎重,其意义有待进一步探讨。      

1380例手术后的非小细胞肺癌的多因素预后分析

背景与目的 非小细胞肺癌的预后影响因素较多。本研究旨在结合临床资料对非小细胞肺癌术后的预后及其影响因素进行分析。方法 回顾性分析自1996年1月至2003年1月1380例手术治疗的非小细胞肺癌患者的资料，对影响其预后的临床病理因素进行了单因素及多因素分析。结果 全组1、3、5年生存率分别为78．85％、49．78％和38．96％，中位生存时间38．77月。单因素分析显示患者肿瘤大小、病理类型、临床类型（中心型和周围型）、病理分期、淋巴结转移情况、手术方式、术后是否化疗及化疗周期数是影响预后的因素，多因素分析显示肿瘤大小、病理分期、淋巴结转移情况及术后是否化疗和化疗的周期数是影响预后的独立因素。结论 对于手术治疗的非小细胞肺癌患者，肿瘤大小、病理分期、淋巴结转移情况及术后化疗情况是独立的预后因素。     

Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer

We attempted to define the role of surgery in the treatment of small cell lung cancer (SCLC). Of 81 patients with clinically localized SCLC, 36 underwent surgical resection: 19 underwent initial resection with postoperative chemotherapy, while the remaining 17 were treated initially with chemotherapy, then resection. The remaining 45 patients were treated with a combination of chemotherapy and radiotherapy. The 5-year survival for the 36 surgical patients was 38%; median survival time (MST) was 33 months. Nineteen patients treated with postoperative chemotherapy showed a 42% 5-year survival, while 17 patients treated with preoperative chemotherapy showed a 33% 5-year survival. This difference was not significant. However, stage III survival tended to be better in patients with preoperative chemotherapy (MST, 29 months) than in those who had had postoperative chemotherapy only (MST, 17 months). Although survival of the 45 nonsurgical patients was poor, stage I and II patients, or those with complete remission showed a 25% 5-year survival with an MST of 33 months, and a 21% 5-year survival with an MST of 25 months, respectively. We thus concluded that initial resection combined with postoperative chemotherapy is beneficial for patients with stage I, and probably stage II disease. For resectable stage III, particularly in patients with N2 disease, adjuvant resection after chemotherapy may be a favorable choice in the management of SCLC. For advanced stage III, complete remission by chemotherapy should be attempted in combination with radiotherapy.     

单纯Barrett's食管腺癌108例临床分析

目的分析单纯Barrett’s食管腺癌根治性手术切除后加用放、化疗的临床疗效,探讨影响Barrett’s食管腺癌预后的因素。方法回顾性分析108例Barrett’s食管腺癌患者的临床资料及随访结果。行根治性手术切除者92例,其中术后单纯放疗者76例,术后放疗后加用化疗者16例;姑息性手术治疗者16例,其中有4例患者于术中死亡,另12例患者在术后均采用放疗 化疗。放疗采用60钴或6MV-X线,体外常规分割照射,靶区放射治疗总剂量为55～70 Gy;化疗采用FAM或CMF方案4～6个疗程。结果采用Kaplan-Meier法计算其生存率,本组患者1、3、5年生存率分别为81.5%、51.9%和22.2%,其中根治性手术切除后单纯放疗者5年生存率为15.8%,术后放疗加化疗者为75.0%;有肿瘤外侵者5年生存率为9.1%,无肿瘤外侵者为33.3%;有淋巴结转移者5年生存率为14.3%,无淋巴结转移者为33.3%;姑息性手术治疗术后加放、化疗后5年生存率为0。Log rank检验结果显示,差异均有统计学意义(P<0.05)。结论单纯Barrett’s食管腺癌根治性手术切除后,及时加用放、化疗治疗,有助于疗效的提高。影响预后的主要因素为临床分期、肿瘤外侵、淋巴结转移和根治性手术切除后放、化疗措施的应用。     

Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors: a multiinstitutional retrospective analysis of 41 patients

BACKGROUND: The relative roles of surgical resection, radiotherapy, and chemotherapy in the management of patients with intracranial nongerminomatous malignant germ cell tumors have been controversial. The authors retrospectively investigated the results of different treatment regimens in patients with these tumors. METHODS: The records of 41 patients who were treated between 1981 and 2001 were reviewed. They were grouped into patients with a good prognosis (n=3), an intermediate prognosis (n=24), and a poor prognosis (n=14) based on the histology of their tumors. Fifteen patients (37%) underwent surgical resection and received radiotherapy, and 26 patients (63%) also received chemotherapy. The median follow-up of 18 patients who remained alive was 61 months (range, 14-194 months). RESULTS: The 5-year actuarial overall survival rates for patients in the good prognosis, intermediate prognosis, and poor prognosis groups were 100%, 68%, and 8%, respectively. In the analysis, histology alone had a statistically significant impact on overall survival (P<0.0001). All 3 patients in the good prognosis group were treated successfully with surgical resection and radiotherapy. In the intermediate prognosis group, the 5-year actuarial overall survival rate was 44% for patients who underwent surgical resection and received radiotherapy (n=9) and 84% for patients who also received chemotherapy (n=15; P=0.01). Patients in the poor prognosis group who underwent surgical resection and received radiotherapy (n=3) or who underwent incomplete resection and received both radiotherapy and chemotherapy (n=8) all died of disease, whereas 2 of 3 patients who underwent macroscopic total resection and received both radiotherapy and chemotherapy survived free of disease. CONCLUSIONS: The treatment of patients with intracranial nongerminomatous malignant germ cell tumors should be based on tumor histology. For patients who had a good prognosis (mature teratoma with germinoma), surgical resection and radiotherapy were sufficient; however, for patients in the intermediate prognosis group, multimodal treatment, including surgical resection, radiotherapy, and chemotherapy, was effective. Conversely, for patients in the poor prognosis group, more intensive multimodal treatment, including macroscopic total resection, may improve the survival rate.     

IE期鼻腔非霍奇金淋巴瘤预手的多因素分析

目的探讨影响I     

TNM因素对非小细胞肺癌治疗效果的影响

目的 探讨肺部原发肿瘤的大小、淋巴结不同区域的转移及有无远处转移对非小细胞肺癌(NSCLC)综合治疗效果的影响.方法 回顾性分析手术治疗的987例NSCLC患者的临床资料,将其中以手术+化、放疗的574例患者与单纯手术治疗的413例患者进行对比分析.结果 全组患者的1、3、5、10年生存率分别为87.7%、57.5%、54.6%和54.5%.其中综合治疗组的1年生存率高于单纯手术组(P<0.01).在T4患者中,手术+放疗组的5年生存率高于单纯手术组(P<0.05).在N0患者中,手术+化疗组、手术+放疗组与单纯手术组比较,1年生存率差异有统计学意义(均P<0.05);在N1患者中,手术+化疗组、手术+放化疗组与单纯手术组比较,1年生存率差异有统计学意义(P<0.01);在N2患者中,手术+化疗组与单纯手术组比较,1年和3年生存率差异均有统计学意义(均P<0.05).结论 对于NSCLC患者,以手术为主的综合治疗疗效优于单纯手术.对T4患者应加强术后局部放疗,对NO和N1患者应辅以适度化、放疗,对N2患者则应强调辅以足够的化疗.     

Preoperative induction chemotherapy with cisplatin and irinotecan for pathological N(2) non-small cell lung cancer

We conducted a phase I/II study to investigate whether the surgical resection after induction chemotherapy with cisplatin and irinotecan was feasible and could improve the treatment outcome for patients with pathological N(2) non-small cell lung cancer. Fifteen patients with stage IIIA non-small cell lung cancer having mediastinal lymph node metastases proved by mediastinoscopy were eligible. Both cisplatin (60 mg m(-2)) and irinotecan (50 mg m(-2)) were given on days 1 and 8. Patients received two cycles of chemotherapy after 3-4 weeks interval. Induction was followed by surgical resection in 4-6 weeks. Patients who had documented tumour regression after preoperative chemotherapy received two additional cycles of chemotherapy and other patients received radiotherapy postoperatively. After the induction chemotherapy, the objective response rate was 73%. All the 15 patients received surgical resection and complete resection was achieved in 11 (73%) patients. There was no operation-related death and one death due to radiation pneumonitis during postoperative radiotherapy. The median time from entry to final analysis was 46.5 months, ranging from 22 to 68 months. The 5-year survival rate was 40% for all the 15 patients and it was 55% for the 11 patients who underwent complete resection. We conclude that the surgical resection after induction chemotherapy with cisplatin and irinotecan is feasible, and associated with low morbidity and high respectability.     

Esophageal squamous cell carcinoma: the specific limited place of surgery defined by a prospective multivariate study of prognostic factors after surgical approach.

From 1982 to 1990, 181 patients underwent surgery for esophageal squamous cell carcinoma, for which 14 prognostic parameters were prospectively recorded in order to perform a multivariate study. A squamous cell head and neck cancer was associated with the esophageal tumor in 40% of the cases (synchronous 18% and metachronous 22%). Resection was curative (i.e. macroscopically complete) in 128 cases, palliative (i.e. with residual tumor) in 24 cases and not possible in 29 cases. There were 21 deaths in hospital (hospital mortality was 11.7%). One hundred and twenty-two patients received preoperative chemotherapy and 77 received postoperative radiotherapy according to different phase II prospective studies. The 5-year survival rate according to the Kaplan-Meier method was 15.8% (+/- 3.4) for all patients and 23.5% (+/- 4.8) for the patients who had a curative resection. A palliative resection or the invasion of a neighbouring organ was synonymous with incurability, but positive lymph nodes were not considered proof of incurability. The multifactorial study concerning all the patients highlighted two main prognostic parameters: the histological staging according to the Japanese classification (P = 0.0006) and the type of resection (curative or not) (P = 0.006). An objective response to preoperative chemotherapy was the third and last parameter revealed by Cox's model. The multivariate study, which was limited to the 112 patients who were alive after a curative resection, showed that only the stage was an important prognostic factor (P = 0.003), with stages 2 and 3 carrying a worse prognosis. We propose a therapeutic scheme, based on these prognostic data and on the usual pre-therapeutic workup with three additional exams: CT scan measurement of tumor diameter, ultrasound examination +/- fine needle aspiration cytology of supra-clavicular lymph nodes and echo-endoscopy. The aim of this scheme is to limit surgery to the subgroup of patients for whom this modality is really beneficial.