Kiliçgün A, Turna A, Sayar A, Solak O, Urer N, Gürses A
Faculty of Medicine, Department of Thoracic Surgery, Izzey Baysal University, Bolu, Turkey.
Thorac Cardiovasc Surg. 2010 Mar;58(2):93-7. doi: 10.1055/s-0029-1186240. Epub 2010 Mar 23.
The current staging system provides an anatomical classification of lung tumors; its secondary purpose is to allow the prognostic stratification of patients into homogeneous groups after surgery. In this work, intratumoral perineural invasion, lymphatic and blood vessel invasion together with the necrosis content of the tumor exclusive of the non-small cell cancer staging system were studied.
During a 4-year period, 152 patients operated for non-small cell lung cancer (NSCLC) at our hospital were analyzed. Mean age of patients was 55.7 +/- 10.1 years.
Overall 5-year survival was 42.2 %. Mediastinal lymph node involvement, tumor size, incomplete resection, pneumonectomy, presence of necrosis and perineural invasion were significant prognosticators ( P = 0.03, 0.04, 0.0001, 0.046, 0.0246, < 0.0001, respectively). Multivariate analysis revealed that N status, perineural invasion, and the presence of necrosis were independent prognostic factors ( P = 0.006, P = 0.001, P = 0.001, respectively). Patients who had stage I tumor with necrosis and perineural invasion had a lower survival rate than those with stage IIIA tumor without these histopathological features ( P = 0.04). The presence of these histopathological characteristics in stage IIIA patients was a sign of a poorer prognosis ( P = 0.0001).
Perineural invasion and the presence of necrosis independently indicated a dismal prognosis and their prognostic power is comparable to those of the TNM classification. These factors could be candidates for better survival stratification and the indicators of the need for adjuvant therapy in early stage lung cancer patients.
当前的分期系统提供了肺肿瘤的解剖学分类；其次要目的是在手术后将患者的预后分层为同质组。在本研究中，我们研究了非小细胞癌分期系统之外的肿瘤内神经周围浸润、淋巴管和血管浸润以及肿瘤的坏死情况。
在4年期间，我们分析了我院152例接受非小细胞肺癌（NSCLC）手术的患者。患者的平均年龄为55.7±10.1岁。
总体5年生存率为42.2%。纵隔淋巴结受累、肿瘤大小、不完全切除、肺切除术、坏死的存在和神经周围浸润是显著的预后因素（分别为P = 0.03、0.04、0.0001、0.046、0.0246、<0.0001）。多因素分析显示，N分期、神经周围浸润和坏死的存在是独立的预后因素（分别为P = 0.006、P = 0.001、P = 0.001）。伴有坏死和神经周围浸润的I期肿瘤患者的生存率低于没有这些组织病理学特征的IIIA期肿瘤患者（P = 0.04）。IIIA期患者中这些组织病理学特征的存在是预后较差的标志（P = 0.0001）。
神经周围浸润和坏死的存在独立表明预后不良，其预后能力与TNM分类相当。这些因素可能是更好地进行生存分层的候选因素，也是早期肺癌患者辅助治疗需求的指标。
