Survival after resection for primary lung cancer: a population based study of 3211 resected patients
Survival after resection for primary lung cancer: a population based study of 3211 resected patients
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DOI：
10.1136/thx.2005.056481
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发表时间：
2006-08-01
期刊：
影响因子：
10
通讯作者：
Norstein, J.
中科院分区：
文献类型：
--
作者：
Strand, T-E;Rostad, H.;Norstein, J.
背景：很少有基于人群的肺癌切除术后生存率的结果。本研究的目的是提出切除术后的长期生存和量化预后因素survival.Methods：所有诊断为肺癌患者在挪威1993-2002年报告的癌症登记处挪威（n = 19 582）。共有3211例患者接受了手术切除，并纳入分析。收集了1993- 1998年诊断的患者的医院补充信息（包括合并症数据）。分析了1993年至1999年诊断和手术的患者的5年观察和相对生存率。结果：1993 ~ 1999年5年相对生存率为46.4%（n = 2144）：I期疾病为58.4%（n = 1375），II期28.4%（n = 532），IIIa期15.1%（n = 133），IIIb期24.1%（n = 63），IV期21.1%（n = 41）。IIIb和IV期的高生存率是由于多种肿瘤的贡献。考克斯回归分析确定男性、年龄较大、手术除上中叶切除术外、组织学类型如腺癌和大细胞癌、右侧手术、切除边缘浸润和较大肿瘤大小为不利预后因素。在基于人群的组中，包括老年患者，晚期患者，小细胞肺癌、具有淋巴结浸润的肿瘤和具有多个肿瘤的患者。这些结果质疑目前肺癌TNM系统在肿瘤大小和多种肿瘤分类方面的有效性。
Background: Very few population based results have been presented for survival after resection for lung cancer. The purpose of this study was to present long term survival after resection and to quantify prognostic factors for survival.Methods: All lung cancer patients diagnosed in Norway in 1993-2002 were reported to the Cancer Registry of Norway (n = 19 582). A total of 3211 patients underwent surgical resection and were included for analysis. Supplementary information from hospitals ( including co-morbidity data) was collected for patients diagnosed in 1993-8. Five year observed and relative survival was analysed for patients diagnosed and operated in 1993-9. Factors believed to influence survival were analysed by a Cox proportional hazard regression model.Results: Five year relative survival in the period 1993-9 was 46.4% (n = 2144): 58.4% for stage I disease ( n = 1375), 28.4% for stage II ( n = 532), 15.1% for IIIa ( n = 133), 24.1% for IIIb ( n = 63), and 21.1% for stage IV disease ( n = 41). The high survival in stage IIIb and IV was due to the contribution of multiple tumours. Cox regression analysis identified male sex, higher age, procedures other than upper and middle lobectomy, histologies such as adenocarcinoma and large cell carcinoma, surgery on the right side, infiltration of resection margins, and larger tumour size as non-favourable prognostic factors.Conclusions: Survival was favourable for resected patients in a population based group including subgroups such as elderly patients, those with advanced stage, small cell lung cancer, tumours with nodal invasion, and patients with multiple tumours. These results question the validity of the current TNM system for lung cancer with regard to tumour size and categorization of multiple tumours.