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目的分析影响右肺PN2非小细胞肺癌术后无复发转移及预后的因素,探讨最佳治疗方案。方法分析1999年9月～2002年3月24例术后病理确诊的右肺PN2非小细胞肺癌,随机分为辅助化疗组(术前或术后)与直接手术组,手术均为完全性切除,采用右肺叶或右全肺+系统性纵隔淋巴结清扫术。术后标本采用免疫组化法行抑癌基因p53,癌基因HER2,表皮生长因子受体(EGFR)等基因表达检测。分析病理分型,手术方式,术前辅助治疗,基因表达,淋巴结转移区域,肺门淋巴结转移,最高纵隔淋巴结转移等因素对预后的影响。结果24例患者2年生存率46%。辅助化疗,EGFR为影响术后无复发转移的重要因素。KaplanMeier生存分析显示辅助化疗与生存有影响,多变量COX回归分析未发现影响预后的独立因素。结论以手术为主的综合治疗是右肺PN2非小细胞肺癌较好的治疗模式。EGFR高表达与术后复发转移有关,对此类患者术后是否应加用靶点治疗需进一步的研究。
Objective To analyze the factors that affect the recurrence and metastasis of non-small cell lung cancer of right lung after non-small cell lung cancer (NSCLC) and to explore the best treatment plan. Methods From September 1999 to March 2002, 24 patients with pathologically confirmed right lung PN2 non-small cell lung cancer were randomly divided into adjuvant chemotherapy group (preoperative or postoperative) and direct surgery group, and the surgery was complete resection , The right lobe or right lung + systemic mediastinal lymph node dissection. Immunohistochemistry was used to detect the gene expression of tumor suppressor gene p53, oncogene HER2 and epidermal growth factor receptor (EGFR) in postoperative specimens. The effects of pathological classification, operation method, preoperative adjuvant therapy, gene expression, lymph node metastasis, hilar lymph node metastasis and the highest mediastinal lymph node metastasis on prognosis were analyzed. Results The 24-year survival rate was 46% in 24 patients. Adjuvant chemotherapy and EGFR are important factors that influence the recurrence and metastasis after operation. Survival analysis of KaplanMeier showed that adjuvant chemotherapy had an impact on survival, and independent variables influencing prognosis were not found in multivariable COX regression analysis. Conclusion The comprehensive treatment based on surgery is a better treatment mode for right lung PN2 non-small cell lung cancer. EGFR overexpression is associated with postoperative recurrence and metastasis, and further research is needed on whether these patients should be treated with target therapy after surgery.