Department of General Thoracic, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
Eur J Cardiothorac Surg. 2011 Jun;39(6):963-7. doi: 10.1016/j.ejcts.2010.09.008. Epub 2010 Oct 15.
The seventh edition of the TNM Classification of Malignant Tumours was published in 2009. The present study was conducted to investigate the clinicopathological features of p-T1aN0M0 non-small-cell lung cancer, which is the earliest stage defined in the new tumor, node, metastasis (TNM) classification, in relation to patient prognosis.
We retrospectively studied 162 patients, who underwent surgical resection at our institution for p-T1aN0M0 non-small-cell lung cancer, as re-categorized in the seventh TNM classification. Univariate and multivariate analyses of disease-free survival were performed.
The mean tumor size was 13.2 ± 4.7 mm. The maximum tumor diameter was >10 mm in 104 cases (64.6%), and ≤ 10 mm in 58 (35.4%). The median follow-up period was 44.5 months. Univariate analysis showed that the 5-year disease-free survival rate of patients with and without preoperative serum carcinoembryonic antigen elevation was 50.8% and 95.1% (P<0.0001), respectively, that of patients with and without blood vessel or lymphatic invasion was 40.0% and 95.8% (positive vs negative, P<0.0001), respectively, and that of patients aged ≥ 70 years and <70 years was 86.8% and 96.1% (P=0.014), respectively. Multivariate analysis including these three clinicopathologic factors demonstrated that preoperative elevation of the carcinoembryonic antigen level and blood vessel or lymphatic invasion were independent prognostic factors.
In patients with p-T1aN0M0 non-small-cell lung cancer, an elevated preoperative carcinoembryonic antigen level and blood vessel or lymphatic invasion tend to affect prognosis to a greater degree than tumor size. Therefore, the efficacy of adjuvant chemotherapy for these patients should be evaluated in clinical trials.
第七版《恶性肿瘤 TNM 分类》于 2009 年出版。本研究旨在探讨新的肿瘤、淋巴结、转移（TNM）分类中定义的最早阶段 p-T1aN0M0 非小细胞肺癌的临床病理特征与患者预后的关系。
我们回顾性研究了在我院接受手术切除 p-T1aN0M0 非小细胞肺癌的 162 例患者，这些患者按第七版 TNM 分类重新分类。对无病生存进行单因素和多因素分析。
肿瘤平均大小为 13.2 ± 4.7mm。最大肿瘤直径>10mm 者 104 例（64.6%），≤10mm 者 58 例（35.4%）。中位随访时间为 44.5 个月。单因素分析显示，术前血清癌胚抗原升高患者与未升高患者的 5 年无病生存率分别为 50.8%和 95.1%（P<0.0001），有血管或淋巴管侵犯患者与无血管或淋巴管侵犯患者的 5 年无病生存率分别为 40.0%和 95.8%（阳性与阴性，P<0.0001），年龄≥70 岁患者与<70 岁患者的 5 年无病生存率分别为 86.8%和 96.1%（P=0.014）。包括这三个临床病理因素的多因素分析显示，术前癌胚抗原升高和血管或淋巴管侵犯是独立的预后因素。
在 p-T1aN0M0 非小细胞肺癌患者中，术前癌胚抗原升高和血管或淋巴管侵犯较肿瘤大小更能影响预后。因此，应在临床试验中评估这些患者辅助化疗的疗效。
