Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Department of Pathology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Chest. 2011 Jul;140(1):135-145. doi: 10.1378/chest.10-2391. Epub 2010 Dec 16.
The purpose of this study is to evaluate the significance of histology as a predictor of recurrence after resection in patients with early-stage non-small cell lung cancer.
A total of 1,870 consecutive patients in stage I and II with adenocarcinoma or squamous cell carcinoma (SCC) who underwent complete tumor resection with systematic lymph node dissection between August 1992 and December 2007 were included.
In patients with SCC, significantly more tumors were stage IB or higher. Ever smokers were more common in patients with SCC, and more patients with SCC died of other diseases. In stage IA, a statistically significant difference in the 5-year recurrence-free probability was observed between adenocarcinoma and SCC (91.4% and 82.6%, respectively; P < .001), whereas no such difference was observed in stage IB (74.4% and 73.6%, respectively; P = .934). In stage II, the 5-year recurrence-free probability for adenocarcinoma was significantly lower than that for SCC (47% and 73%, respectively; P < .001). In stage IA, patients with predominantly bronchioloalveolar carcinoma subtype were more common compared with stage IB or higher in patients with adenocarcinoma.
It is important to offset the prognostic impact of comorbidities associated with cigarette smoking because more patients with SCC died of other diseases. When evaluating its significance as a predictor of recurrence stratified by stage, histology showed a different impact on postoperative recurrence within different substages. Histologic subtype distribution was different among substages in patients with adenocarcinoma. Disease stages should be considered while evaluating histology as a predictor of recurrence.
本研究旨在评估组织学作为预测早期非小细胞肺癌切除后复发的指标的意义。
共纳入 1870 例连续的 I 期和 II 期腺癌或鳞状细胞癌（SCC）患者，他们于 1992 年 8 月至 2007 年 12 月期间接受了完整肿瘤切除术和系统淋巴结清扫术。
在 SCC 患者中，更多的肿瘤为 IB 期或更高期。SCC 患者中经常吸烟者更为常见，且更多 SCC 患者死于其他疾病。在 IA 期，腺癌和 SCC 之间的 5 年无复发生存率存在统计学显著差异（分别为 91.4%和 82.6%；P<0.001），而在 IB 期则无差异（分别为 74.4%和 73.6%；P=0.934）。在 II 期，腺癌的 5 年无复发生存率明显低于 SCC（分别为 47%和 73%；P<0.001）。在 IA 期，与 IB 期或更高期相比，腺癌中以细支气管肺泡癌为主的患者更为常见。
由于更多的 SCC 患者死于其他疾病，因此抵消与吸烟相关的合并症对预后的影响很重要。当根据分期评估其作为复发预测指标的意义时，组织学在不同亚分期对术后复发的影响不同。腺癌患者中各亚分期的组织学亚型分布不同。在评估组织学作为复发预测指标时，应考虑疾病分期。
