121例手术切除的N2-Ⅲa期非小细胞肺癌患者的生存分析

BACKGROUND AND OBJECTIVE: It has still been controversial to treat N2-Ⅲa non-small cell lung cancer (NSCLC) patients by surgery or non-surgery. We retrospectively analysed the survival of 121 stage N2-Ⅲa NSCLC patients and explored their postoperatively long-term prognostic factors. METHODS: All of 1, 290 patients in Beijing Cancer Hospital underwent resection by single-surgeon-team, among which 121 cases with stage N2-Ⅲa were enrolled in the study. We retrospectively analysed the impact of gender, age, smoking, perioperative chemotherapy, incision, histological type, vascular tumor emboli, pTstage and tumor size on survival of stage N2-Ⅲa patients, and compared the survival between patients with single-and multi-station N2 metastasis, and between intraoperatively or postoperatively pathological N2 (Ⅲa1/a2) and preoperative N2 (Ⅲa3/a4). Univariate analysis was conducted by Kaplan-Meier curve, and significance test was performed by Log-rank test and Cox regression factor analysis was applicated for multivariate analysis. RESULTS: The 5-yr of all the 121 cases was 43.6%, with a median survival time being 50.3 mo. Univariate analysis showed the 5-yr of patients with single-and multi-station N2 metastasis were 58.3% and 25.5%, respectively (P=0.001), 5-yr of patients with stage Ⅲa1/a2 and stag Ⅲa3/a4 were 52.7% and 38.4%, respectively (P=0.020). Multivariate analysis demonstrated that only single station N2 (HR=0.326, 95%CI: 0.186-0.572, P < 0.001) and Ⅲa1/a2 (HR=0.494, 95%CI: 0.259-0.941, P=0.032) were independent prognostic factors for stage N2-Ⅲa lung cancer patients. CONCLUSION: The prognosis of stage N2-Ⅲa NSCLC patients with single-station N2 metastasis were better than those with multi-station N2 metastasis. Besides, Ⅲa1/a2 patients had a better survival compared with stage Ⅲa3/a4 patients. A multi-disciplinary comprehensive treatment based on surgery may allow patients with high selective stage N2-Ⅲa NSCLC to obtain a comparatively satisfying long-term survival.