摘要目的 通过回顾性分析,探讨肺鳞状细胞癌的综合治疗策略和预后及其影响因素.方法 分析2004年1月至2007年1月接受完全性切除手术的450例肺鳞状细胞癌患者临床资料,其中男性363例,女性87例；年龄31～82岁,平均年龄60.5岁,中位年龄62岁.探讨肺鳞状细胞癌综合治疗策略,通过随访分析预后及影响预后的临床因素.结果 术后5年生存率为52.4％.Cox回归多因素分析显示:术前影像纵隔淋巴结状态(x2=18.969,P=0.000)、N分期(x2=44.069,P=0.000)、TNM分期(x2=63.025,P=0.000)是肺鳞状细胞癌独立的预后影响因素.术后辅助化疗是Ⅱ～ⅢA期患者的预后因素(5年生存率48.9％比37.7％,x2=3.946,P=0.047).关于ⅢA期患者术后综合治疗,放化疗组生存最佳,其次是单独化疗组和未治疗组,单独放疗组预后最差,5年生存率分别为48.8％、35.9％、28.5％、11.1％,差异有统计学意义(x2=8.397,P=0.038).结论 通过提升手术标准,达到甚至超过完全性手术切除的淋巴结清扫可使肺鳞状细胞癌5年生存率明显提高.Ⅱ～ⅢA期患者能够从术后辅助化疗中获益,ⅢA期患者应予以手术联合放化疗的综合治疗模式.术前影像提示纵隔淋巴结多组肿大融合怀疑转移者,手术应该慎行.

abstractsObjective To study the treatment strategy and prognosis and its affected factors of lung squamous cancer according retrospective analysis.Methods Clinic data of 450 lung squamous cancer inpatient cases who were performed complete resection from January 2004 to January 2007,was retrospectively reviewed.There were 363 male and 87 female patients,aged from 31 to 82 years,with a mean of 60.5 years and a median of 62 years.Results The overall 5-year survival rate was 52.4％.Cox Regression suggested that preoperative N status(x2 =18.969,P =0.000),N stage(x2 =44.069,P =0.000)and TNM stage(x2 =63.025,P =0.000)are independent factors affecting the prognosis.Adjuvant chemotherapy affects the prognosis of stage Ⅱ-ⅢA lung squamous cancer(5-year survival rate: 48.9％ vs.37.7％,x2 =3.946,P =0.047).Studying the combined therapy of stage Ⅲ A,the chemoradiotberapy group achieved the best survival(48.8％),then single chemotherapy group(35.9％)and no treatment group(28.5％),and the single radiotherapy group achieved the poorest survival rate(11.1％),and there were statistically significant differences among them(x2 =8.397,P =0.038).Conclusions The 5-year survival rate of lung squamous cancer has significantly increased through promoting the standard of operation,especially increasing the standard of lymph node dissection.Adjuvant chemotherapy is benefit for stage Ⅱ-ⅢA patients and combined chemoradiotherapy is the best choice for stage ⅢA patients.If preoperative examination suggests mediastinal lymph node's enlargement and fusion,the operation should not be performed.