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新辅助化疗后胸腔镜手术对Ⅲa-N2期NSCLC患者血清CYFRA21-1、NSE的影响
作者:张芳  吕蓓丽  赵于天  蔡礼鸣 
单位:江南大学附属医院, 江苏 无锡 214000
关键词:胸腔镜手术 新辅助化疗 非小细胞肺癌 细胞角蛋白19片段抗原 神经元特异性烯醇化酶 
分类号:R734.2
出版年·卷·期(页码):2018·37·第九期(1009-1014)
摘要:

目的:探讨新辅助化疗后胸腔镜手术对初诊Ⅲa-N2期非小细胞肺癌(NSCLC)患者血清细胞角蛋白19片段抗原(CYFRA21-1)和神经元特异性烯醇化酶(NSE)表达水平的影响。方法:选择初诊Ⅲa-N2期NSCLC患者82例,随机分为观察组(n=41)与对照组(n=41)。观察组术前新辅助化疗后实施胸腔镜手术,对照组直接行胸腔镜手术。比较两组手术情况、治疗前后血清CYFRA21-1、NSE水平及临床预后。结果:两组淋巴结清扫数、手术时间、术后并发症率比较,差异无统计学意义(P>0.05);观察组手术切除率显著高于对照组(95.12%vs 78.05%,P<0.05),术中出血量显著短于对照组(P<0.05);治疗后观察组的血清CYFRA21-1、NSE水平显著低于对照组(P<0.05);两组1年复发转移率(20.59%vs 33.33%,P>0.05)、1年生存率比较无明显差异(88.24%vs 76.67%,P>0.05),观察组3、5年复发转移率显著低于对照组(35.29%vs 56.67%、58.82%vs 86.67%,P<0.05),3、5年生存率较对照组显著提高(67.65%vs 53.33%、41.18%vs 20.00%,P<0.05)。结论:新辅助化疗后胸腔镜手术能够提高初诊Ⅲa-N2期NSCLC患者的手术切除率及近期疗效,不增加术后并发症,且能降低血清CYFRA21-1、NSE水平。

Objective: To investigate the influence of thoracoscopic surgery after neoadjuvant chemotherapy on serum levels of cytokeratin 19 fragment antigen (CYFRA21-1) and neuron-specific enolase (NSE) in patients with newly diagnosed stage Ⅲa-N2 non-small cell lung cancer (NSCLC). Methods: 82 cases of patients with newly diagnosed stage Ⅲa-N2 NSCLC were randomly divided into observation group (n=41) and control group (n=41). The observation group underwent thoracoscopic surgery after preoperative neoadjuvant chemotherapy, the control group underwent thoracoscopic surgery. The surgical conditions and clinical outcomes of the two groups were compared. Serum CYFRA21-1 and NSE levels were measured before and after treatment. Results: There was no significant difference in the number of lymph node dissections, operation time and postoperative complications between the two groups (P>0.05),the surgical resection rate in the observation group was significantly higher than that in the control group (95.12% vs 78.05%, P<0.05), and the amount of blood loss in the observation group was significantly shorter than that in the control group (P<0.05). The serum levels of CYFRA21-1 and NSE in the observation group after treatment were significantly lower than those in the control group (P<0.05). There was no significant difference in 1-year recurrence metastasis rate (20.59% vs 33.33%,P>0.05) and survival rates between the two groups (88.24% vs 76.67%, P>0.05),while the 3-and 5-year recurrence metastasis rates in the observation group were significantly lower than those in the control group (35.29% vs 56.67%,58.82% vs 86.67%;P<0.05),the 3-and 5-year survival rates in the observation group were significantly higher than those in the control group (67.65% vs 53.33%,41.18% vs 20.00%;P<0.05). Conclusion: Thoracoscopic surgery after neoadjuvant chemotherapy can significantly improve the resection rate and therapeutic effect without increase of complications,which can reduce serum CYFRA21-1, NSE levels.

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