Wisnivesky Juan P, Yankelevitz David, Henschke Claudia I
Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029, USA.
Chest. 2004 Sep;126(3):761-5. doi: 10.1378/chest.126.3.761.
The objective of this study was to determine the relationship between tumor size and curability of stage I non-small cell lung cancer.
From the Surveillance, Epidemiology, and End Results registry 2003, we identified all primary non-small cell lung cancer cases that were diagnosed prior to autopsy. Among these cases, we narrowed the focus to those diagnosed in 1988 or later, and to 7,620 patients who had undergone curative surgical resection. Kaplan-Meier survival curves were obtained for these stage I malignancies for five tumor size categories (ie, 5 to 15 mm, 16 to 25 mm, 26 to 35 mm, 36 to 45 mm, and > 45 mm). The 12-year Kaplan-Meier estimator of survival was used as a measure of lung cancer cure rate.
Among 7,620 stage I cancers, cure rates decreased with increasing tumor size. The 12-year survival rates for patients with tumors 5 to 15 mm in diameter was 69% (95% confidence interval [CI], 64 to 74%), 63% for those with tumors 16 to 25 mm in diameter (95% CI, 60 to 67%), 58% for those with tumors 26 to 35 mm in diameter (95% CI, 54 to 61%), 53% for those with tumors 36 to 45 mm in diameter (95% CI, 48 to 57%), and 43% for those with tumors > 45 mm in diameter (95% CI, 39 to 48%). Cure rates were statistically significantly different for all tumor size categories (p < 0.05) except for the groups with tumors 26 to 35 mm and 36 to 45 mm in diameter (p = 0.10).
Smaller tumor size at diagnosis is associated with improved curability within stage I non-small cell lung cancers. These results suggest that further subclassification by size within stage I may be important.
本研究的目的是确定肿瘤大小与Ⅰ期非小细胞肺癌可治愈性之间的关系。
从2003年监测、流行病学和最终结果登记处，我们识别出所有在尸检前被诊断的原发性非小细胞肺癌病例。在这些病例中，我们将重点缩小到1988年或之后被诊断的病例，以及7620例接受了根治性手术切除的患者。针对这Ⅰ期恶性肿瘤的五个肿瘤大小类别（即5至15毫米、16至25毫米、26至35毫米、36至45毫米和大于45毫米）获得了Kaplan-Meier生存曲线。12年的Kaplan-Meier生存估计值被用作肺癌治愈率的衡量指标。
在7620例Ⅰ期癌症中，治愈率随着肿瘤大小的增加而降低。直径为5至15毫米肿瘤患者的12年生存率为69%（95%置信区间[CI]，64至74%），直径为16至25毫米肿瘤患者的生存率为63%（95%CI，60至67%），直径为26至35毫米肿瘤患者的生存率为58%（95%CI，54至61%），直径为36至45毫米肿瘤患者的生存率为53%（95%CI，48至57%），直径大于45毫米肿瘤患者的生存率为43%（95%CI，39至48%）。除了直径为26至35毫米和36至45毫米肿瘤的组（p = 0.10）外，所有肿瘤大小类别的治愈率在统计学上均有显著差异（p < 0.05）。
诊断时较小的肿瘤大小与Ⅰ期非小细胞肺癌中提高的可治愈性相关。这些结果表明，在Ⅰ期内按大小进一步细分可能很重要。
