Sayar Adnan, Turna Akif, Solak Okan, Kiliçgün Ali, Urer Nur, Gürses Atilla
Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Zeytinburnu, Istanbul, Turkey.
Ann Thorac Surg. 2004 Feb;77(2):421-5. doi: 10.1016/S0003-4975(03)01645-X.
A number of prognostic factors have been reported for resected nonsmall cell lung carcinoma. Although none of them reported to have greater prognostic impact than the TNM staging system, which is based on anatomical descriptions of tumors, the prognoses of a significant number of patients are not in agreement with real survival of the patients. Moreover, certain histopathologic properties of the tumor (such as lymphatic and vascular invasion) could help to predict the survival of the patients.
A retrospective study was conducted on 82 surgically resected nonsmall cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, clinical and surgical-pathologic T and N status, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion.
Lymphatic invasion and perineural invasion of the tumor were found to be significant prognostic factors (p = 0.02 and p = 0004). Blood vessel invasion (venous or arterial involvement) had no prognostic impact (p > 0.05). According to multivariate analyses, three factors were selected as prognostic indicators: (1) clinical N status (p = 0.027), (2) lymphatic invasion (p = 0.027) and (3) perineural invasion (p = 0.0148). By combining these factors we identified a poor prognostic subgroup of patients with stage I disease.
Our study showed that lymphatic vessel and perineural invasion of the tumor could be prognostic factors, along with anatomical determinants such as cN and surgical-pathologic stage of the pulmonary carcinoma.
已报道了多种关于可切除非小细胞肺癌的预后因素。尽管据报道这些因素中没有一个比基于肿瘤解剖学描述的TNM分期系统具有更大的预后影响，但相当一部分患者的预后与实际生存情况并不相符。此外，肿瘤的某些组织病理学特征（如淋巴管和血管侵犯）有助于预测患者的生存情况。
对82例手术切除的非小细胞肺癌进行回顾性研究，在单因素分析中评估以下预后因素：年龄、性别、临床和手术病理T和N状态、肿瘤组织学类型、分化程度、淋巴管侵犯、血管侵犯和神经周围侵犯。
发现肿瘤的淋巴管侵犯和神经周围侵犯是显著的预后因素（p = 0.02和p = 0.004）。血管侵犯（静脉或动脉受累）无预后影响（p > 0.05）。根据多因素分析，选择三个因素作为预后指标：（1）临床N状态（p = 0.027），（2）淋巴管侵犯（p = 0.027）和（3）神经周围侵犯（p = 0.0148）。通过综合这些因素，我们确定了I期疾病患者的一个预后不良亚组。
我们的研究表明，肿瘤的淋巴管和神经周围侵犯可能是预后因素，与诸如cN和肺癌手术病理分期等解剖学决定因素一起。
