切除卫星结节型T4非小细胞肺癌的预后因素

Prognostic factors in resected satellite-nodule T4 non-small cell lung cancer.

作者信息

Rao Jagan, Sayeed Rana A, Tomaszek Sandra, Fischer Stefan, Keshavjee Shaf, Darling Gail E

机构信息

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

出版信息

Ann Thorac Surg. 2007 Sep;84(3):934-8; discussion 939. doi: 10.1016/j.athoracsur.2007.04.097.

DOI:10.1016/j.athoracsur.2007.04.097

PMID:17720402

Abstract

BACKGROUND

The 1997 non-small cell lung cancer staging revisions assigned a T4 descriptor to satellite nodules in the primary tumor lobe. We reviewed our experience of satellite-nodule T4 non-small cell lung cancer following these revisions and evaluated prognostic factors for this group.

METHODS

All patients who underwent resection of non-small cell lung cancer between April 1997 and June 2005 with satellite nodule(s) confirmed at pathologic examination were identified from our institutional Lung Tumor Registry. Case notes and pathology reports were reviewed and data collected on possible prognostic factors. Survival was modeled using the Kaplan-Meier method, and survival differences between groups were analyzed using the log-rank test.

RESULTS

From 1,276 non-small cell lung cancer patients who underwent resection, 137 were staged pT4, and 35 were T4-satellite nodules. Median follow-up was 25 months (range, 1 to 102 months). Median main tumor size was 3.0 cm (range, 1 to 9.8 cm). Adenocarcinoma or bronchioloalveolar carcinoma was the predominant histologic diagnosis (n = 28; 80%). One-, 3- and 5-year survival was 86%, 69%, and 57%, respectively; median survival was 68 months. During the same period, 137 patients undergoing resection for all T4 lesions had a 1-, 3-, and 5-year survival of 68%, 53%, and 18%, respectively. Adenocarcinoma or bronchioloalveolar carcinoma histologic diagnosis (adenocarcinoma or bronchioloalveolar carcinoma versus squamous, 75% versus 67% 3-year survival; p = 0.0026), female gender (66% versus 49% for males, 5-year survival; p = 0.041), and absence of vascular invasion (no invasion versus vascular invasion, 74% versus 20% 5-year survival; p = 0.0101) were significant predictors of better survival.

CONCLUSIONS

Survival for resected T4 non-small cell lung cancer with satellite nodule(s) in the primary lobe is better than for other T4 lesions, and the T4 descriptor may unduly upstage these cases. The current T4 descriptor represents a heterogeneous population.

摘要

背景

1997年非小细胞肺癌分期修订版将原发肿瘤叶内的卫星结节定义为T4描述符。我们回顾了在这些修订之后我们关于卫星结节T4非小细胞肺癌的经验，并评估了该组患者的预后因素。

方法

从我们机构的肺肿瘤登记处识别出1997年4月至2005年6月期间接受非小细胞肺癌切除术且病理检查确诊有卫星结节的所有患者。查阅病历和病理报告，并收集关于可能的预后因素的数据。采用Kaplan-Meier方法对生存情况进行建模，使用对数秩检验分析组间生存差异。

结果

在1276例接受切除术的非小细胞肺癌患者中，137例分期为pT4，其中35例为T4卫星结节。中位随访时间为25个月（范围1至102个月）。主要肿瘤的中位大小为3.0厘米（范围1至9.8厘米）。腺癌或细支气管肺泡癌是主要的组织学诊断（n = 28；80%）。1年、3年和5年生存率分别为86%、69%和57%；中位生存期为68个月。同期，137例接受所有T4病变切除术的患者1年、3年和5年生存率分别为68%、53%和18%。腺癌或细支气管肺泡癌组织学诊断（腺癌或细支气管肺泡癌与鳞状细胞癌相比，3年生存率75%对67%；p = 0.0026）、女性（男性5年生存率为49%，女性为66%；p = 0.041）以及无血管侵犯（无侵犯与血管侵犯相比，5年生存率74%对20%；p = 0.0101）是生存较好的显著预测因素。