非小細胞肺癌における系統的縦隔リンパ節郭清の検討

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  • BENEFITS OF SYSTEMIC MEDIASTINAL LYMPHADENECTOMY IN NON-SMALL CELL LUNG CANCER

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Benefits of systemic mediastinal lymphadenectomy were investigated in 288 patients with non-small cell lung cancer resected in our clinic from 1979 through 1993. Sampling mediastinal lymphadenectomy (R1) had been performed as our standard method before 1985 (the earlier period), and systemic mediastinal lymphadenectomy (R2-3) has been adopted since 1986 (the latter period). The 5-year survival rates of the patients in the earlier and latter period were 34.2% and 58.1% (p<0.01), respectively. In pN0+1 disease, the 5-year survival rate in the R1 group was 42.4% versus 72.3% in the R2-3 group (p<0.01). And the 5-year survival rates were 36.8% in the R1 group of the earlier period and 69.0% in the R1-3 group of the latter period (p<0.01). In pN2+3 disease, the 5-year survival rate of the R2-3 group was 21.4% versus 7.0% in the R1 group (p<0.03). The 5-year survival rate was 0% inthe R1 group of the earlier period and 19.1% in the R1-3 group of the latter period, but there was no significant difference (p=0.24). These results imply that in pN2 or pN3 disease with poor prognosis, we have to investigate some more aggressive systemic lymphadenectomy as well as more effective multimodal therapy.

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