Department of Surgery, Washington University in St. Louis, St. Louis, Missouri 63110, USA.
Ann Thorac Surg. 2010 Apr;89(4):1053-9. doi: 10.1016/j.athoracsur.2010.01.020.
Conventional thoracic surgical teaching suggests a worse outcome for lower lobe lung cancers. It is unclear whether this is due to stage migration or whether lobar location is an independent negative prognostic factor.
We performed a retrospective review of our institutional database of patients undergoing resection for pathologic stage I or stage II lung cancer between Jan 2000 and December 2006. Survival analysis was used to compare outcomes in various groups using the log-rank test. Logistic regression analysis was used to compare the primary dependent variables; age, size, and location of tumor (both laterality and lobe), histology (adenocarcinoma, squamous, large cell, or neuroendocrine and others) and type of resection (wedge, lobectomy or segmentectomy, and pneumonectomy).
A total of 841 patients met the inclusion criteria. The mean age of patients was 64.9 years, mean tumor size 3.3 cm, and, 144 patients had N1 disease. The three-year and five-year survivals for stage I tumors were 346 of 478 (72.4%) and 277 of 497 (55.7%), respectively. There was no difference in survival based upon lobar location. The three-year and five-year survivals for stage II tumors were 81 of 175 (46.3%) and 39 of 150 (26%), respectively, and lobar location did not influence survival. Logistic regression analysis showed that for stage I tumors increasing age and having undergone a pneumonectomy were associated with worse survival, and for stage II tumors increasing age and adenocarcinoma histology were associated with worse survival.
Tumor location within the lung does not predict survival in pathologic stage I/II non-small cell lung carcinoma. Increasing age, adenocarcinoma histology, and pneumonectomy as the resection may lead to worse long-term survival.
传统的胸外科教学认为下叶肺癌的预后较差。目前尚不清楚这是由于分期迁移还是肺叶位置是独立的预后不良因素。
我们对 2000 年 1 月至 2006 年 12 月期间接受病理 I 期或 II 期肺癌切除术的机构数据库进行了回顾性分析。使用对数秩检验对不同组的生存结果进行生存分析。使用逻辑回归分析比较主要依赖变量；年龄、肿瘤大小和位置（侧位和肺叶）、组织学（腺癌、鳞状细胞癌、大细胞癌或神经内分泌癌等）和切除类型（楔形切除术、肺叶切除术或节段切除术以及全肺切除术）。
共有 841 例患者符合纳入标准。患者的平均年龄为 64.9 岁，平均肿瘤大小为 3.3cm，144 例患者有 N1 疾病。I 期肿瘤的 3 年和 5 年生存率分别为 478 例中的 346 例（72.4%）和 497 例中的 277 例（55.7%）。肺叶位置与生存率无差异。II 期肿瘤的 3 年和 5 年生存率分别为 175 例中的 81 例（46.3%）和 150 例中的 39 例（26%），肺叶位置也不影响生存率。逻辑回归分析表明，对于 I 期肿瘤，年龄增加和全肺切除术与生存率降低相关，而对于 II 期肿瘤，年龄增加和腺癌组织学与生存率降低相关。
肺内肿瘤位置不能预测病理 I/II 期非小细胞肺癌的生存情况。年龄增加、腺癌组织学和全肺切除术可能导致长期生存较差。
