Factors determining outcome after surgical resection of T3 and T4 lung cancers of the superior sulcus
Factors determining outcome after surgical resection of T3 and T4 lung cancers of the superior sulcus
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DOI：
10.1067/mtc.2000.106089
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发表时间：
2000-06-01
影响因子：
6
通讯作者：
Ginsberg, RJ
中科院分区：
文献类型：
--
作者：
Rusch, VW;Parekh, KR;Ginsberg, RJ
背景：上沟肺癌的治疗正在不断发展，术前化疗的使用越来越多。为了建立评估新疗法的历史基准，我们回顾了 24 年因上沟肺癌接受开胸手术的患者的经验。方法：通过回顾性图表审查获得数据。采用Kaplan和Meier方法计算总生存率，并采用对数秩和Cox比例风险模型检查预后因素。结果：从1974年到1998年，225名患者接受了开胸手术。患者包括 144 名男性 (64%) 和 81 名女性，中位年龄为 55 岁。大多数患者（55%）接受了术前放疗，但 35% 的患者没有接受任何术前治疗。 52% 的患者肿瘤分期为 IIB (T3 NO)，15% 为 IIIA，27% 为 IIIB。 64% 的 T3 NO 肿瘤、54% 的 T3 N2 肿瘤和 39% 的 T4 N0 肿瘤实现了完全切除。手术死亡率为4%。 IIB 期的中位生存期为 33 个月，IIIA 期和 IIIB 期的中位生存期均为 12 个月。 IIB 期精算 5 年生存率为 46%，IIIA 期为 0%，IIIB 期为 13%。通过单变量和多变量分析，T 和 N 状态以及完全切除对生存有显着影响。局部区域疾病是最常见的复发形式。结论：我们的结果提供了评估新治疗方案的基准。控制局部疾病仍然是治疗上沟肺癌的主要挑战。术前化疗或放化疗的潜在益处必须通过是否能提高完全切除率和降低局部复发风险来评估。
Background: The treatment of superior sulcus lung cancers is evolving and preoperative chemotherapy is increasingly used. To establish a historical benchmark against which new therapies can be assessed, we reviewed our 24-year experience with patients undergoing thoracotomy for lung cancers of the superior sulcus.Methods: Data were acquired through retrospective chart review. Overall survival was calculated by the method of Kaplan and Meier, and prognostic factors were examined by log rank and Cox proportional hazards modeling.Results: From 1974 to 1998, 225 patients underwent thoracotomy. The patients included 144 men (64%) and 81 women with a median age of 55 years. The majority of patients (55%) received preoperative radiation, but 35% did not have any preoperative treatment. Tumor stages were IIB (T3 NO) in 52%, IIIA in 15%, and IIIB in 27% of patients. Complete resection was achieved in 64% of T3 NO tumors, 54% of T3 N2 tumors, and 39% of T4 N0 tumors. Operative mortality was 4%. Median survival was 33 months for stage IIB and 12 months for both stages IIIA and IIIB. Actuarial 5-year survivals were 46% for stage IIB, 0% for stage IIIA, and 13% for stage IIIB. By univariate and multivariable analyses, T and N status and complete resection had a significant impact on survival. Locoregional disease was the most common form of relapse.Conclusions: Our results provide a benchmark against which new treatment regimens can be evaluated. Control of locoregional disease remains the major challenge in treating lung cancers of the superior sulcus. The potential benefit of preoperative chemotherapy or chemoradiotherapy must be assessed by whether it leads to higher rates of complete resection and a lower risk of local relapse.