Ⅲ期非小细胞肺癌手术是否有价值

BACKGROUND AND OBJECTIVE: Nowadays, comprehensive treatment, including surgery, chemotherapy and radiotherapy is advocated for stage Ⅲ non-small cell lung cancer (NSCLC). However, many researchers have questioned the effectiveness of surgery. The aim of this study is to evaluate the effect of surgery for stage Ⅲ NSCLC. METHODS: Between March 2002 and October 2012, 310 cases that have completed followed-up data with stage Ⅲ NSCLC were received in the Peking Union Medical College Hospital. They were divided into surgical and non-surgical groups according to whether received surgery when diagnosed. In TNM staging, stage Ⅲ NSCLC includes stage Ⅲa and Ⅲb, and stage Ⅲa NSCLC can be grouped into stage T4N0/T3-4N1M0 and T1-3N2M0 according to different N stages. Analyzed the enumeration data by Chi-Square test. Kaplan-Meier survival method was used to calculate the overall survival (OS) and progression-free survival (PFS), and to draw the survival curves. A P value less than 0.05 was evaluated as statistically significant. RESULTS: Three hundred and ten stage Ⅲ NSCLC patients include surgical group 189 cases and non-surgical group 121 cases. One hundred and eighty-eight stage Ⅲa NSCLC patients include surgical group 152 cases and non-surgical group 36 cases. In stage Ⅲa, stage T4N0/T3-4N1M0 had 57 patients with 44 surgical and 13 non-surgical patients, and stage T1-3N2M0 had 131 patients with 108 surgical and 23 non-surgical patients. Thirty-seven out of 121 stage Ⅲb NSCLC patients received surgery. They had 22 stage T4N2M0 cases and 15 stage T1-4N3M0 cases. The patient whose performance status was 0 and staging was stage Ⅲa was more inclined to undergo surgery. For stage Ⅲa NSCLC patients, the median OS of surgical and non-surgical groups were 38.9 and 21.8 months, and the median PFS of them were 19.2 and 11.9 months respectively. The difference of OS between the two groups was significant (P=0.041), but the PFS of them had no significant difference (P=0.209). For stage T4N0/T3-4N1M0 which belongs to stage Ⅲa, the median OS of surgical and non-surgical groups were 48.7 and 20.1 months, and the median PFS of them were 14.6 and 10.5 months respectively. There were no significant differences of OS and PFS between the two groups (P>0.05). For stage T1-3N2M0 which also belongs to stage Ⅲa, the median OS of surgical and non-surgical groups were 38.9 and 30.8 months, and the median PFS of them were 19.8 and 12.7 months respectively. There were also no significant differences of OS and PFS between the two groups (P>0.05). The maximum diameter of tumor and auxillary chemotherapy had significant influences on OS and PFS of stage Ⅲa-N2 NSCLC patients, while the histology of tumor only influenced the OS of them (P < 0.05). CONCLUSION: The patient whose performance status is 0 and staging is stage Ⅲa is more inclined to undergo surgery. Surgery can prolong OS of patients with stage Ⅲa, especially for stage T4N0/T3-4N1M0. However, it has no benefit on PFS. The maximum diameter of tumor and auxillary chemotherapy have significant influences on OS and PFS of stage Ⅲa-N2 NSCLC patients, while the histology of tumor only influence the OS of them.