Patterns of the first failure in completely resected stage Ⅲ<sub>A</sub>(N<sub>2</sub>) non-small cell lung cancer

张　琴; 傅小龙; 蔡旭伟

doi:10.19401/j.cnki.1007-3639.2017.05.010

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Patterns of the first failure in completely resected stage Ⅲ_A(N₂) non-small cell lung cancer

更新时间：2025-12-31

- Patterns of the first failure in completely resected stage Ⅲ_A(N₂) non-small cell lung cancer
- China Oncology Vol. 27, Issue 5, Pages: 383-388(2017)
- 作者机构：
  
  上海交通大学附属胸科医院放疗科,上海,200030
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2017.05.010
  CLC：
- Published Online：14 June 2017，
  
  Published：14 June 2017
- 稿件说明：
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张　琴, 傅小龙,蔡旭伟,等. 手术完全切除的Ⅲ

张　琴, 傅小龙, 蔡旭伟. Patterns of the first failure in completely resected stage Ⅲ_A(N₂) non-small cell lung cancer[J]. China Oncology, 2017, 27(5): 383-388.
张　琴, 傅小龙,蔡旭伟,等. 手术完全切除的Ⅲ DOI： 10.19401/j.cnki.1007-3639.2017.05.010.

张　琴, 傅小龙, 蔡旭伟. Patterns of the first failure in completely resected stage Ⅲ_A(N₂) non-small cell lung cancer[J]. China Oncology, 2017, 27(5): 383-388. DOI： 10.19401/j.cnki.1007-3639.2017.05.010.

摘要

背景与目的：Ⅲ

)期非小细胞肺癌(non-small cell lung cancer，NSCLC)总体生存不佳，5年生存率为15%~30%。该研究旨在探讨Ⅲ

)期NSCLC患者肿瘤完全切除术后患者的首次失败表型，明确各部位远处转移发生的风险，为术后治疗的选择提供临床依据。方法：对2005年1月—2012年7月收治的经手术完全切除的Ⅲ

)期NSCLC患者进行回顾性分析。观察患者无进展生存期(progression-free survival，PFS)、总生存期(overall survival，OS)、首次失败表型以及首次失败表型的发生率和发生时间。生存分析和首次失败发生率采用Kaplan-Meier法计算。结果：入组患者共357例。全组患者的中位PFS为20.0个月，OS为43.1个月，5年总生存率为36.9%。病程中284例(77.6%)患者出现进展，首次失败表型：61例局部区域复发，197例远处转移，26例进展时既有局部区域复发又有远处转移。首次失败表型是远处转移中最主要的转移部位是脑、骨、肺，其中脑最常见，共67例患者。首次失败表型是局部区域复发的中位时间是13.6个月，而首次失败表型是远处转移的中位时间是15.1个月。首次失败表型是脑转移发生时间均较早，92.5%的患者均在3年内发生。结论：手术完全切除的Ⅲ

)期NSCLC的首次失败表型中，远处转移显著高于局部区域复发；脑是远处转移作为首次失败表型最常见的部位。本研究为该类患者化疗时间的选择、术后放疗价值以及是否需要行全脑预防性放疗提供了一定的理论依据。

Abstract

Background and purpose: The prognosis of completely resected stage Ⅲ

) non-small cell lung cancer (NSCLC) remains a significant concern. The 5-year overall survival (OS) rates range from 10% to 30%. This study aimed to analyze the patterns of first failure in completely resected stage Ⅲ

) NSCLC and to assess the actuarial risk of developing metastasis a

t different sites and to guild standard clinical practice. Methods: Patients with Ⅲ

) NSCLC who had undergone radical surgery in our hospital from Jan. 2005 to Jul. 2012 were retrospectively reviewed. The progression-free survival (PFS)

the OS

patterns of first failure

the actuarial risk were analyzed. The cumulative incidence of first failure was determined using the Kaplan-Meier analysis. Results: Among 357 patients who met the eligibility criteria with completely resected stage Ⅲ

) NSCLC

5-year OS was 36.9%. There were 284 (77.6%) patients experiencing disease failure: 61 with local failure

197 with local and distant failures

and 26 patients with local recurrence as the first failure. Brain

bone and lung were the main sites of distant failure as the first failure

while brain was the most common site. There were 67 patients developing brain metastases (BM) as the first site of failure. The median time of local failure as the first site of failure was 13.6 months

and the time to develop distant recurrence was 15.1 months. 92.5% BM developed in 3 years after the complete resection. Conclusion: As the first failure

the rate of distant failure was much higher than that of local failure in completely resected stage Ⅲ

) NSCLC. Brain was the most common site of distant failure as the first failure. These results can be helpful in guiding standard clinical practice and evaluating the outcome of comprehensive treatment.

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Patterns of the first failure in completely resected stage ⅢA(N2) non-small cell lung cancer

DOI：10.19401/j.cnki.1007-3639.2017.05.010

摘要

Abstract

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Patterns of the first failure in completely resected stage Ⅲ_A(N₂) non-small cell lung cancer