Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea.
Lung Cancer. 2011 Aug;73(2):222-9. doi: 10.1016/j.lungcan.2010.11.013. Epub 2010 Dec 18.
Patients with stage I-II non-small cell lung cancer (NSCLC) show variability in recurrence after curative resection. Several factors have been proposed as prognostic of recurrence in previous studies. However, because of the heterogeneity of the populations studied, these reports did not yield consistent results. The aim of our study was to identify risk factors for recurrence in patients with curatively resected stage I-II NSCLC.
We reviewed the medical records of pathological stage I-II NSCLC patients after curative surgery performed in a tertiary referral center (Seoul National University Hospital) from January 2002 to December 2004. Demographic factors, radiological, histopathological, and laboratory findings, and surgery-related factors were analyzed. Patients with invasive cancer other than lung cancer that was present 5 years prior to surgery were excluded. The Cox proportional hazard regression model was used for multivariate analyses.
Three hundred and ten patients were included. Among them, local recurrence occurred in 27 patients (8.7%), whereas distant recurrence occurred in 79 patients (25.5%). Adenocarcinoma histology (OR, 2.74; 95% CI, 1.14-6.58; P=0.024), carcinoembryonic antigen (CEA) level>2.3 ng/mL (OR, 2.26; 95% CI, 1.02-5.00; P=0.045), and standard uptake values (SUV) of tumor in positron emission tomography (PET)>4.5 (OR, 5.45; 95% CI, 1.82-16.31; P=0.002) were independent predictors of recurrence in addition to TNM stage. We also constructed a recurrence prediction model based on these findings, which yielded better diagnostic performance than the TNM staging system.
Adenocarcinoma histology, CEA level, and SUV of PET could be considered as prognostic factors for recurrence in patients with curatively resected stage I-II NSCLC.
I 期-II 期非小细胞肺癌（NSCLC）患者在根治性切除术后的复发情况存在差异。在之前的研究中，已经提出了一些因素作为复发的预后指标。然而，由于研究人群的异质性，这些报告并未得出一致的结果。我们的研究目的是确定根治性切除的 I 期-II 期 NSCLC 患者复发的危险因素。
我们回顾性分析了 2002 年 1 月至 2004 年 12 月在一家三级转诊中心（首尔国立大学医院）接受根治性手术治疗的 I 期-II 期 NSCLC 患者的病历。分析了人口统计学因素、影像学、组织病理学和实验室检查以及手术相关因素。排除了 5 年前患有手术前存在的非肺癌侵袭性癌症的患者。使用 Cox 比例风险回归模型进行多变量分析。
共纳入 310 例患者。其中，27 例（8.7%）发生局部复发，79 例（25.5%）发生远处复发。腺癌组织学（OR，2.74；95%CI，1.14-6.58；P=0.024）、癌胚抗原（CEA）水平>2.3ng/mL（OR，2.26；95%CI，1.02-5.00；P=0.045）和正电子发射断层扫描（PET）中肿瘤的标准摄取值（SUV）>4.5（OR，5.45；95%CI，1.82-16.31；P=0.002）是除 TNM 分期外预测复发的独立因素。我们还根据这些发现构建了一个复发预测模型，该模型的诊断性能优于 TNM 分期系统。
腺癌组织学、CEA 水平和 PET 的 SUV 可作为根治性切除的 I 期-II 期 NSCLC 患者复发的预后因素。
