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目的评估非小细胞肺癌根治性切除术后转移规律与预后之间的相关性。方法回顾性分析2005年1月至2011年12月于我院胸外科行根治性肺叶切除的非小细胞肺癌患者94例的临床资料,分析术后转移规律与预后之间的关系。男53例、女41例,年龄62(57~76)岁。结果全组两年以后发生转移者占52.12%(49/94),90.43%(85/94)患者发生单系统转移。最常见的术后转移部位为肺组织(38/94,40.42%)、骨转移(27/94,28.72%)、脑转移(24/94,25.53%)。随访终点94例入组患者总生存率为41.5%。单系统转移患者和多系统转移患者的生存率分别为45.9%和0.0%(P<0.001)。两年内发生单系统转移患者和转移时间超过两年患者组的总生存率分别为53.3%和30.6%(Cox P=0.130,Breslow P=0.014)。Cox回归对与生存率相关因素进行分析,结果显示TNM分期为Ⅰ~Ⅱ期(P=0.003)以及单系统转移(P<0.001)与生存率呈正相关。结论非小细胞肺癌根治性切除术后容易发生肺组织、骨骼以及脑转移,术后发生多系统转移的患者预后较差。
Objective To evaluate the correlation between metastasis and prognosis in patients with non-small cell lung cancer after radical resection. Methods The clinical data of 94 patients with non-small cell lung cancer who underwent radical lobectomy in our department from January 2005 to December 2011 were retrospectively analyzed. The relationship between postoperative metastasis and prognosis was analyzed. 53 males and 41 females, aged 62 (57 to 76) years old. Results In the whole group, 52.12% (49/94) had metastasis two years later and 90.43% (85/94) had single system metastasis. The most common postoperative metastatic sites were lung (38/94, 40.42%), bone metastases (27/94, 28.72%) and brain metastases (24/94, 25.53%). 94 patients at the end of follow-up showed a total survival rate of 41.5%. Survival rates in patients with single-system and multiple-system metastases were 45.9% and 0.0%, respectively (P <0.001). Overall survival was 53.3% and 30.6% for patients who had a single-system metastasis within two years and those who had metastatic metastases for more than two years (Cox P = 0.130, Breslow P = 0.014). Cox regression analysis of survival-related factors showed that TNM stage Ⅰ ~ Ⅱ (P = 0.003) and single-system metastasis (P <0.001) were positively correlated with the survival rate. Conclusions Lung tissue, bone and brain metastases are more likely to occur after radical resection of non-small cell lung cancer. Patients with multiple system metastases after surgery have a poor prognosis.