未行术后放疗ⅢA～N2期非小细胞肺癌首次局部复发模式及其相关因素
Journal of Chinese Oncology（2019）
Abstract
[目的]探讨未行术后放疗的ⅢA～N2期非小细胞肺癌(NSCLC)首次局部复发模式及其影响因素,为高危淋巴引流区照射范围的设计提供依据.[方法]回顾分析本院2012年至2015年初治的病例资料完整的ⅢA～N2期NSCLC患者75例,纳入条件为接受根治性手术,病理证实为ⅢA～N2期NSCLC,未行新辅助治疗或术后放疗,术后行辅助化疗,首次复发涉及局部区域,具有首次复发影像资料.[结果]局部复发时间为3～45月,中位局部复发时间为11月,伴有远处转移37例,不伴远处转移38例.全组复发最高危部位为4R(44％)、7区(43％)、残端(27％).左上叶肺癌多见复发部位(＞10％)为7区、4R、同侧肺门、2R、2L、4L、5区和残端.左下叶肺癌多见复发部位(＞10％)为4R、7区、4L、5区、同侧肺门和残端.右上中叶肺癌多见复发部位(＞10％)为4R、7区、2R、3P、残端和同侧肺门.右下叶肺癌多见复发部位(＞10％)为7区、残端和4R、同侧肺门.鳞癌和腺癌残端复发比例分别为56.3％ (9/16)和18％ (9/50) (P=0.003).肿瘤直径≥5cm和肿瘤直径＜5cm患者残端复发比例分别为44％(11/25)和18％(9/50) (P=0.016).N2跳跃转移和N2非跳跃转移的患者同侧肺门复发比例分别为7.5％(3/40)31.4％(11/35)(P=0.008).[结论]未行术后放疗的ⅢA～N2期NSCLC不同原发部位的高危复发区域不同,且首次局部复发模式受病理类型、肿瘤大小、N2跳跃转移影响,术后放疗靶区设计应考虑上述因素.
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