Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Results of Selected Stage IIIB Non-small Cell Lung Cancer

병기 IIIB 비소세포암 환자에서의 수술 성적

  • 민호기 (성균관대학교 삼성서울병원 흉부외과교실) ;
  • 김형수 (성균관대학교 삼성서울병원 흉부외과교실) ;
  • 유정우 (성균관대학교 삼성서울병원 흉부외과교실) ;
  • 최용수 (성균관대학교 삼성서울병원 흉부외과교실) ;
  • 김관민 (성균관대학교 삼성서울병원 흉부외과교실) ;
  • 김진국 (성균관대학교 삼성서울병원 흉부외과교실) ;
  • 장봉현 (경북대학교 의과대학 흉부외과학교실) ;
  • 심영목 (성균관대학교 삼성서울병원 흉부외과교실)
  • Published : 2003.03.01
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Abstract

Traditionally, patients with stage IIIB non small cell lung cancer (NSCLC) have been con-sidered Inoperable due to the short-term survival rate of this disease. However, some recent papers have reported good surgical treatment results for T4 lesions in stage IIIB NSCLC. This study reports the results of stage IIIB NSCLC patients who underwent surgical treatment at our institute. Material and Method: This study includes 109 patients who were diagnosed with pathological stage IIIA lung cancer and 59 patients who were diagnosed with pathological stage IIIB at our institute between 1994 to December 2001. Patients who underwent neo-adjuvant chemotherapy and radiation therapy were excluded from this study. According to the TNM classification, 13 patients from stage IIIA were classified into T3N1, 12 into T1N2, 73 into T2N2 and 11 into T3N2. Stage IIIB patients consisted of 26 patients with T4N0, 18 with T4Nl, 14 with T4N2, and 1 with T4N3. Result: The 30-day mortality for stage IIIA and IIIB were 4.58% and 5.08% respectively. The overall survival rate at the 1st, 2nd, 3rd, and 5th year were 69.1%, 53.7%, 41.6%, and 30.7% respectively in stage IIIA and 68.8%, 55.6%, 42.9%, and 35.9% respectively in stage IIIB. Patients with satellite nodules in the same lobe & no Iymph node involvement had a survival rate of 53.9% in 3 years compared with 15.2% in patients with satellite nodules in the same lobe with Iymph node involvement. Conclusion: Surgical treatment is recommended for selected stage IIIB NSCLC patients (pathological N0 stage & completely resectable patients), particularly for patients with satellite nodules in the same lobe & no lymph node involvement.

전통적으로 병기 IIIB 비소세포암은 낮은 장기 생존율로 인해 수술이 불가능하다고 여겨져 왔다. 그러나 최근의 몇몇 보고에서는 병기 IIIB 중 74 병변에서 수술 후 좋은 장기 생존율을 보고하고 있다. 본원에서 일부 선택된 병기 IIIB 환자에서의 수술 경험을 보고하고자 한다. 대상 및 방법: 1994 년부터 2001년 12월까지 본원에서 원발성 폐암으로 진단을 받고 수술을 시행한 936명의 환자 중 수술 후 조직 검사상 병기 IIIA 및 IIIB로 진단받은 환자에서 수술 전 항암치료나 방사선치료를 받은 환자를 제외한 각각 109명과 59명을 대상으로 하였다. TNM 병기에 따른 분류상 병기 IIIA의 경우 T3Nl이 13예, T1N2가 12예, T2N2가 73예였으며 T3N2가 11예였다. 그리고 병기 IIIB의 경우는 T4N0가 26예, T4Nl이 18예, T4N2가 14예였으며 T4N3가 1예였다. 결과: 수술 관련 사망률은 병기 IIIA에서는 4.58%였고 병기 IIIB에서는 5.08%였다. 병기 IIIA와 IIIB의 1년, 2년, 3년, 5년 생존율은 각각 69.1%, 53.7%, 41.6%, 30.7%였고 68.9%, 55.6%, 42.9%, 35.9%였다. T4 병변에 의한 병기 IIIB 폐암에서 같은 엽에 소결절이 있는 군을 다시 림프절 전이가 없는 군과 림프절 전이가 있는 군으로 나누어 생존율을 구하였을 때 림프절 전이가 없는 군에서 유의하게 생존율이 높았다(p=0.0118). 결론: 림프절의 전이가 없고 완전 절제가 가능한 병기 IIIB 환자에서 수술적 절제를 적극적으로 고려하여야겠고 특히 림프절 전이가 없는 한 엽에 여러 소결절이 있는 환자에서는 수술적 치료를 요한다 하겠다.

Keywords

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