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[目的]探讨非小细胞肺癌(NSCLC)根治术后局部复发患者的预后影响因素。[方法]回顾性分析87例NSCLC根治术后局部复发患者的临床资料,分析局部复发部位的差异及生存情况。[结果]原发病灶同侧肺残端、肺门、纵隔复发(78.2%)比例远高于对侧肺门、纵隔及双侧锁骨上区(21.8%)(χ2=131.713,P=0.000)。全组患者复发后中位生存时间21.0个月,1、2、4年累积生存率分别为68.1%、44.5%和12.4%。单因素分析显示:复发间隔时间长、复发后再分期早、放化疗联合治疗以及复发后放疗剂量大于60Gy为预后有利因素,COX模型多因素分析显示仅复发后再分期为独立预后因素。[结论]NSCLC根治术后辅助放疗应以同侧肺门及纵隔为主;对于一般情况较好、复发后再分期早的患者建议放化疗联合治疗并尽可能提高放疗剂量以进一步提高疗效。
[Objective] To investigate the prognostic factors of patients with local recurrence after radical operation of non-small cell lung cancer (NSCLC). [Methods] The clinical data of 87 patients with local recurrence after radical operation of NSCLC were retrospectively analyzed. The differences and survival of local recurrence were analyzed. [Results] The rate of recurrence of hilar and hilar and mediastinum (78.2%) in primary lesion was much higher than that in contralateral hilar, mediastinum and bilateral supraclavicular region (χ2 = 131.713, P = 0.000) . The median survival time was 21.0 months after recurrence in all the patients. The cumulative survival rates at 1, 2 and 4 years were 68.1%, 44.5% and 12.4% respectively. Univariate analysis showed that long time recurrence, early relapse and relapse after radiotherapy and chemotherapy combined with radiotherapy dose greater than 60 Gy after relapse were favorable prognostic factors. Multivariate analysis of COX model showed that recurrence and re-staging were independent prognostic factors. [Conclusions] Adjuvant radiotherapy should focus on ipsilateral hilar and mediastinum after radical resection of NSCLC. In general, patients with relapse after re-staging are advised to combine radiotherapy and chemotherapy with radiotherapy and chemotherapy as much as possible to further improve the curative effect.