Efficacy of video-assisted thoracoscopic surgery lobectomy combined with mediastinal lymph node dissection in treating stage Ⅲ A non-small cell lung cancer
Objective To explore the efficacy of video-assisted thoracoscopic surgery(VATS)lobectomy combined with me-diastinal lymph node dissection(MLND)in treating stage Ⅲ A non-small cell lung cancer(NSCLC),aiming to provide evi-dence for the clinical treatment of NSCLC patients.Methods A retrospective analysis was conducted on the clinical data of stage Ⅲ A NSCLC patients admitted to the Second Affiliated Hospital of Air Force Medical University from June 2017 to De-cember 2021.A total of 57 patients who underwent open lobectomy combined with MLND were selected as the control group by cluster random sampling,and 63 patients who underwent VATS combined with MLND were selected as the obser-vation group.The serum tumor marker levels,pulmonary function indicators,short-term solid tumor efficacy,2-year fol-low-up survival,and complications within 6 months after treatment were compared between the two groups.Results The operation time of patients in the observation group was longer than that in the control group,and the number of lymph nodes dissected was more than that in the control group,with both differences being statistically significant(P<0.05).The drainage time and length of hospital stay of patients in the observation group were significantly shorter than those in the con-trol group,and the blood loss was significantly less than that in the control group(P<0.05).Before treatment,no statisti-cally significant differences were noted in the levels of serum carcinoembryonic antigen(CEA),carbohydrate antigen 50(CA50),cytokeratin 19 fragment(CYFRA21-1),and squamous cell carcinoma-related antigen(SCC)between the two groups(P>0.05).The levels of serum CEA,CA50,CYFRA21-1,and SCC in both groups decreased 6 months after treat-ment,and all were lower in the observation group than in the control group,with all differences being statistically significant(P<0.05).Before treatment,no statistically significant differences were observed in the levels of maximum voluntary ven-tilation(MVV),forced vital capacity(FVC),and forced expiratory volume in 1 second(FEV1)between the two groups(P>0.05).The levels of MVV,FVC,and FEV1 in both groups decreased 6 months after treatment,but all were higher in the observation group than in the control group,with statistically significant differences(P<0.05).Six months after treat-ment,no statistically significant difference was found in the disease control rate(DCR)between the two groups(P>0.05).The objective response rate(ORR)of patients in the observation group was significantly higher than that in the control group(P<0.05).No statistically significant differences were noted in DCR and ORR between different TNM-stage patients(P>0.05).Besides,no statistically significant difference was noted in the 2-year survival rate between the two groups(X2=2.409,P=0.121).The progression-free survival(PFS)of patients in the observation group was significantly longer than that in the control group(t=2.842,P=0.005).No statistically significant difference was noted in overall survival time(OS)between the two groups(t=0.308,P=0.758).The incidence of complications within 6 months after treatment in the observation group was significantly lower than that in the control group(P<0.05).Conclusion For stage Ⅲ A NSCLC patients,the short-term and long-term efficacy of VATS combined with MLND treatment is ideal,which helps to restore patients'lung function,and the risk of complications is controllable.This provides various alternative options for clinical treatment.It is recommended that the clinic should choose the best treatment plan based on the actual situation of the patients after full communication with the patients.