Matsuguma Haruhisa, Nakahara Rie, Igarashi Seiji, Ishikawa Yoshinori, Suzuki Haruko, Miyazawa Naoto, Honjo Satoshi, Yokoi Kohei
Division of Thoracic Surgery, Tochigi Cancer Center, Utsunomiya, Japan.
J Thorac Cardiovasc Surg. 2008 Jan;135(1):44-9. doi: 10.1016/j.jtcvs.2007.09.032.
Surgery alone remains the standard therapy for patients with stage I non-small cell lung cancer. Although the preoperative serum level of carcinoembryonic antigen has been shown to be an independent prognostic factor, it has not yet been included in the staging system and does not alter the treatment strategy, especially in the selection of patients for adjuvant chemotherapy.
From 1986 to 2003, preoperative and postoperative serum carcinoembryonic antigen levels were measured in 455 patients with completely resected pathologic stage I non-small cell lung cancer. We compared the clinicopathologic characteristics and outcomes among patients who had preoperative serum carcinoembryonic antigen levels within the normal range (N group, n = 323), patients who had high carcinoembryonic antigen levels before surgery but normal levels after surgery (HN group, n = 112), and patients who had high carcinoembryonic antigen levels before and after surgery (HH group, n = 20).
The significant characteristics of the HN group included the male sex, greater age, smoking, squamous cell histology, T2 status, lymphatic invasion, vascular invasion, and pleural invasion. Adenocarcinomas in patients of the HN group were more likely to be moderately to poorly differentiated. The 5-year survivals in the HN and HH groups were significantly lower (56.2% and 43.1%, respectively) than those in the N group (85.9%). Multivariate analysis revealed that greater age, non-adenocarcinoma histology, pleural invasion, and the carcinoembryonic antigen in the HN and HH groups were independent prognostic factors.
Patients with resected pathologic stage I non-small cell lung cancer and high preoperative serum carcinoembryonic antigen levels are a subgroup with a distinctly poor prognosis who display smoking-related clinicopathologic characteristics.
对于Ⅰ期非小细胞肺癌患者，单纯手术仍然是标准治疗方法。虽然术前血清癌胚抗原水平已被证明是一个独立的预后因素，但它尚未被纳入分期系统，也不会改变治疗策略，尤其是在辅助化疗患者的选择方面。
1986年至2003年，对455例经病理证实为完全切除的Ⅰ期非小细胞肺癌患者进行了术前和术后血清癌胚抗原水平检测。我们比较了术前血清癌胚抗原水平在正常范围内的患者（N组，n = 323）、术前癌胚抗原水平高但术后正常的患者（HN组，n = 112）和术前及术后癌胚抗原水平均高的患者（HH组，n = 20）的临床病理特征及预后。
HN组的显著特征包括男性、年龄较大、吸烟、鳞状细胞组织学、T2期、淋巴浸润、血管浸润和胸膜浸润。HN组患者的腺癌更可能为中分化至低分化。HN组和HH组的5年生存率（分别为56.2%和43.1%）显著低于N组（85.9%）。多因素分析显示，年龄较大、非腺癌组织学、胸膜浸润以及HN组和HH组的癌胚抗原是独立的预后因素。
切除的病理Ⅰ期非小细胞肺癌且术前血清癌胚抗原水平高的患者是一个预后明显较差的亚组，具有与吸烟相关的临床病理特征。
