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題名 | Surgical Treatment of N [feaf]Non-Small Cell Lung Cancer=非小型細胞肺癌合併同側縱隔腔淋巴結轉移的外科治療 |
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作者姓名(中文) | 饒綽立; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 25:1 民81.01-02 |
頁次 | 頁978-987 |
分類號 | 416.224 |
關鍵詞 | 非小型細胞肺癌; 縱隔腔淋巴結轉移; 外科治療; |
語文 | 英文(English) |
中文摘要 | 在過去九年間,本院胸腔外科共施行了798個肺癌手術。其中有131個病患手術後經過病理診斷為非小型細胞肺癌合併同側縱隔腔淋巴結轉移,發生率為16.4%。131位病患中,共有115位男性及16位女性,平均年齡60.8歲。而在這131位病患當中,有117位接受根除性肺癌切除術,切除率是81.7%。有5位病患因手術而死亡(3.8%)及10位發生手術併發症(7.6%)。這131位病患二年的累積存活率是32.8%,五年的累積存活率7.8%。於107位接受根除性手術的病患當中,二年及五年的累積存活率是39.5%及9.6%。相對的,在24位腫瘤無法切除的病患中,則沒有二年及五年的存活,比較起來,深具統計學的差異。 在這回溯性的統計分析當中,如果病患在手術前就發現鹼性磷酸酯酶、乳酸去氫酶或腫瘤胚胎抗原值升高,手術後的預後較差。同時,手術前經由胸部電腦斷層檢查就懷疑有同側縱隔腔淋巴結轉移的病患,其預後也較差。若腫瘤合併有臟壁胸膜侵犯,預後也較不佳。至於手術種類、組織學分類、縱隔腔淋巴結侵犯的範圍,以及是否接受手術後輔助性療法等,手術後累積存活率則都沒有統計學上的差異。 雖然對於肺癌合併有同倒縱隔腔淋巴結轉移的所有病患當中,手術可能只使部份病患得到長期存活,但目前若單以化學或放射線療法,是無法達到如此的效果。所以,對於影響預後因素的進一步了解,可使我們能更審慎的選出適當的病患,施以積極的根除性手術,而達成癌病手術的治療效果。 |
英文摘要 | Between July 1980 and June 1989, among 798 patients with lung cancer underwent thoracotomy at our division, 131 patients were proved with N2 non-small cell lung cancer, and an incidence of 16.4 %. Of these 131 patients, 115 were males, and 16 females. The mean age was 60.8 years, ranging from 40 to 78 years. The complete resection of tumor had been performed for 107 out of these 131 patients, and resectability was 81.7%. There were 5 patients died of operative complications, and thus the operative mortality was 3.8%. The rate of the overall cumulative survival for these 131 patients was 32.8% of 2 years, and 7.8% of 5 years, respectively. Besides, the cumulative 2- and 5-year survivals were significantly better in the resected group (n=107), compared with the unresectable group (n=24)(39.5% v.s. 0 of 2 years, 9.6% v.S. 0 of 5 years, respectively, p<0.001). This retrospective study showed that an elevation in alkaline phosphatase, lactate dehydrogenase, and carcinoembryonic antigen (CEA) at admission indicated a poorer prognosis. Moreover, among 102 patients with N2 lesions proved at thoracotomy, the patients (n=34) with N2 lesions shown in chest CT scanning had a significantly poorer survival as compared to those (n=68) without N2 lesions shown in chest CT scanning (22.3% v.S. 50.1% of 2 years, 0 v.s.14.5% of 5 years, respectively, p<0.001). Our results also revealed that the extent of pulmonary resection, histologic types, and the status of N2 nodes involved did not influence the survival. The patients with tumors involving the visceral pleurae, however, resulted in poorer prognosis (20.8% v.s. 44.9% of 2 years, 8.3% v.s. 11.8% of 5 years, respectively, p=0.02). The postoperative adjuvant therapy did not influence the survival in our series (p=0.08). Although the surgical resection may only salvage a few patients with N2 lung cancers, no other effective management could improve the long-term survivals currently. Thus, an aggressive surgical resection is still recommended to be the choice of treating N2 non-small cell lung cancer. For some selective patients with N2 non-small celllung cancers, the actural surgical benefits can be achieved. |
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