A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer
A review of 250 ten-year survivors after pneumonectomy for non-small-cell lung cancer
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DOI：
10.1093/ejcts/ezt494
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发表时间：
2014-05-01
影响因子：
3.4
通讯作者：
Le Pimpec-Barthes, Francoise
中科院分区：
文献类型：
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作者：
Riquet, Marc;Mordant, Pierre;Le Pimpec-Barthes, Francoise
在过去的几十年里，肺切除术越来越被视为一种危险的手术，首先保留给不适合肺叶切除的肿瘤，现在甚至在晚期非小细胞肺癌（NSCLC）中也不鼓励。我们的目的是评估肺切除术后NSCLC的长期生存率及其预后因素，我们进行了一项回顾性研究，包括1981年至2002年在法国2个中心接受肺切除术的NSCLC患者。在研究期间，我们对1466例NSCLC患者进行了肺切除术，包括1121例标准和345例扩展，并占总人群。396例患者（27%）发生术后并发症，其中93例死亡（6.3%）。5年和10年生存率分别为32%和19%。250例患者术后存活> 10年，并占研究组。研究组包括大多数男性（n = 230，92%），平均年龄为57 ± 9.2岁，大多数为临床IIIA期（n = 117，46.8%）。分别在41例（16.4%）、109例（43.6%）、40例（16%）和97例（38.8%）患者中进行了诱导、右侧全肺切除术、扩大切除术和辅助治疗。组织学显示大多数鳞状细胞癌（n = 181，72.4%）、T2肿瘤（n = 117，36.8%）和N1疾病（n = 105，42%）。多因素分析显示，年龄大、晚期、扩大切除范围、非致死性术后并发症、腺癌、淋巴管微浸润、N1和N2病变、R1和R2切除是影响预后的主要因素。在过去的30年中，全肺切除术对晚期NSCLC的治疗是有效的，10年生存率为19%。其他非手术治疗的结果尚未报道，证实了肺切除术仍然是治疗肺癌的基本武器。
During the last decades, pneumonectomy has been increasingly seen as a risky procedure, first reserved for tumours not amenable to lobectomy, and now discouraged even in advanced stages of non-small-cell lung cancer (NSCLC). Our purpose was to assess the long-term survival following pneumonectomy for NSCLC and its prognostic factors.We set a retrospective study including every patient who underwent a pneumonectomy for NSCLC in 2 French centres from 1981 to 2002. We then described the demographic and pathological characteristics of patients who survived > 10 years, and studied the prognostic factors of long-term survival.During the study period, 1466 pneumonectomies were performed for NSCLC, including 1121 standard and 345 extended, and accounted for the overall population. Postoperative complications occurred in 396 patients (27%), including 93 deaths (6.3%). Five- and 10-year survival rates were 32 and 19%, respectively. Two-hundred and fifty patients survived > 10 years after surgery, and accounted for the study group. The study group included a majority of males (n = 230, 92%), a mean age of 57 +/- 9.2 years and a majority of clinical stage IIIA (n = 117, 46.8%). Induction, right-sided pneumonectomy, extended resection and adjuvant therapy were performed in 41 (16.4%), 109 (43.6%), 40 (16%) and 97 patients (38.8%), respectively. Histology revealed a majority of squamous cell carcinoma (n = 181, 72.4%), T2 tumours (n = 117, 36.8%) and N1 disease (n = 105, 42%). In multivariate analysis, factors associated with adverse outcomes included older age, advanced stage, extended resection, non-lethal postoperative complication, adenocarcinoma, lymphatic vessel microinvasion, N1 and N2 disease and R1 and R2 resection.During the last 30 years, pneumonectomy was effectively performed for advanced NSCLC, allowing a 10-year survival rate of 19%. Such results have not been reported with other non-surgical treatments and confirm that pneumonectomy is still an essential weapon in the armamentarium against lung cancer.