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目的探讨非小细胞肺癌跨叶侵犯的合理T分期及适宜的切除范围。方法回顾性分析2007年11月至2015年7月在四川大学华西医院行根治性肺癌切除术51例患者的临床资料。按照第八版新分期,有跨叶侵犯的T2N0M0期患者34例,T3N0M0期17例。以2∶1比例纳入同时期手术局限单叶的T2N0M0、T3N0M0病例和局限单叶的T3N0M0、T4N0M0病例分别与上述两组肺癌跨叶侵犯患者进行倾向性评分匹配后入组,对照组共188例。对不同切除范围的跨叶侵犯肺癌患者的术后生存情况进行了比较。结果各组在年龄、性别、吸烟史等方面情况基本一致。跨叶T2组及单叶T2、T3组的3年及5年生存率分别是73.90%和61.60%,89.60%和89.60%及68.90%和61.20%。生存分析显示,跨叶侵犯T2组的总体生存率(OS)明显低于局限单叶T2组(P=0.042),而与单叶T3组相似(P=0.955)。三组间无进展生存率(PFS)的比较也与OS的结果一致。在跨叶T3组的分析中,其3年和5年OS分别为31.60%和21.00%,也显著低于局限单叶T3组的70.80%和65.70%(P=0.009);而与单叶T4组49.10%和28.00%的水平接近(P=0.343)。然而,跨叶T3期患者的PFS虽也表现出明显短于单叶T3组而更接近单叶T4组水平的趋势,但差异无统计学意义(P1=0.071,P2=0.648)。在跨叶侵犯切除范围的研究中,双叶/全肺切除组和单叶+楔形切除组的患者OS和PFS差异并无统计学意义。但单叶+楔形切除组在术后住院时间[(6.90±3.11)d vs.(9.23±4.43)d,P=0.030]、术后胸腔引流时间[(4.41±2.98)d vs.(6.50±4.11)d,P=0.041]及并发症发生率方面(4.00%vs.31.58%,P=0.032)相比双叶/全肺切除组降低。结论直接跨叶侵犯的肺癌在其T分期中应予以升期:依据第八版分期,直径不超过5 cm的跨叶肿瘤应升级为T3期;而直径5~7 cm的跨叶肿瘤则应被视为T4期肺癌。单叶+楔形切除术是侵犯深度不超过2 cm的周围型跨叶侵犯肿瘤一种合理的手术方式。
Objective To investigate the reasonable T-staging and appropriate resection range of trans-leaf invasion of non-small cell lung cancer. Methods The clinical data of 51 patients undergoing radical resection of lung cancer at West China Hospital of Sichuan University from November 2007 to July 2015 were retrospectively analyzed. According to the eighth edition of the new staging, there are 34 cases of invasive T2N0M0 patients, 17 cases of T3N0M0. The patients with T2N0M0, T3N0M0 and single-lobed T3N0M0 and T4N0M0 with single-lobe operation in the same period were enrolled in the 2: 1 ratio group. The patients in the two groups were compared with the propensity score of the patients with transluminal lung invasion. The control group included 188 cases . Postoperative survival of patients with lung cancer with transversal invasion of different resections was compared. Results The age, gender, smoking history and other aspects of the groups were basically the same. The 3-year and 5-year survival rates of T2-versus-T3 and T2-T3 groups were 73.90% and 61.60%, 89.60% and 89.60% and 68.90% and 61.20%, respectively. Survival analysis showed that the overall survival rate (OS) of the cross-infiltrating T2 group was significantly lower than that of the localized single-lobed T2 group (P = 0.042), but similar to the single-leaf T3 group (P = 0.955). Comparison of progression-free survival (PFS) among the three groups was also consistent with OS. Three-year and five-year OS were 31.60% and 21.00% for the stratified T3 group, which was also significantly lower than 70.80% and 65.70% (P = 0.009) for the localized leaflet T3 group, respectively The levels of 49.10% and 28.00% were similar (P = 0.343). However, there was no significant difference in PFS between patients with T3 transection and T3 but with no significant difference (P = 0.071, P = 0.648). There were no significant differences in OS and PFS between the two-leaf / pneumonectomy group and the single-leaf + wedge resection group in the study of the extent of transsexual resection. However, the postoperative length of stay in the single-leaf + wedge resection group was significantly shorter ([6.90 ± 3.11] d vs. 9.23 ± 4.43 days, P = 0.030) 4.11) d, P = 0.041] and complication morbidity (4.00% vs.31.58%, P = 0.032) compared with the double-lobe / pneumonectomy group. Conclusions Lung cancer with direct leaflet invasion should be elevated in its T stage: according to the eighth edition of staging, transmembrane tumors with a diameter of no more than 5 cm should be upgraded to T3; while transversal tumors with a diameter of 5 to 7 cm should be It is considered T4 stage lung cancer. Single-leaf + wedge resection is a reasonable surgical procedure to encroach on peripherally infiltrating tumors with a depth of no more than 2 cm.