Department of General Thoracic, Breast and Endocrinological Surgery, Kagawa University, Kagawa, Japan.
Eur J Cardiothorac Surg. 2012 Mar;41(3):603-6. doi: 10.1093/ejcts/ezr006.
The seventh edition of the TNM Classification of Malignant Tumours was published in 2009. This study was conducted to investigate the prognostic factors of p-T1aN0M0 pulmonary adenocarcinoma, which is the earliest stage defined in the new TNM classification.
We retrospectively studied 122 patients who underwent lobectomy at our institution for p-T1aN0M0 adenocarcinoma, as re-categorized in the seventh TNM classification. The patients were separated into groups on the basis of the following clinicopathologic parameters: age, < 70 vs. > 70 years; gender, male vs. female; preoperative serum carcinoembryonic antigen (CEA) level, < 5.0 vs. ≥ 5.0 ng/dl; tumour size, <10 vs. >10 mm; intratumoral vascular or lymphatic invasion, positive vs. negative. Univariate and multivariate analyses of disease-free survival were performed.
The median follow-up period was 41.4 months. Univariate analysis showed that prognostic factors such as age, CEA elevation and intratumoral vascular or lymphatic invasion were significant (age, < 70 vs. > 70 years; 97.1% vs. 82.0%, P = 0.0027; preoperative serum CEA level, < 5.0 vs. > 5.0 ng/dl; 93.3% vs. 33.3%, P < 0.0001; intratumoral vascular or lymphatic invasion, positive vs. negative; 31.3% vs. 96.5%, P < 0.0001). Multivariate analysis demonstrated that only intratumoral vascular or lymphatic invasion was a significantly independent prognostic factor (P = 0.0039, Hazard Ratio, 0.066; 95% Confidence Interval, 0.011-0.419).
Intratumoral vascular or lymphatic invasion should always be studied and included in the final pathology report in order to consider potential clinical and therapeutic relevance. The efficacy of adjuvant chemotherapy for these patients should also be evaluated in clinical trials.
第 7 版《恶性肿瘤 TNM 分期》于 2009 年出版。本研究旨在探讨新 TNM 分期中定义的最早阶段 p-T1aN0M0 肺腺癌的预后因素。
我们回顾性研究了在我院接受肺叶切除术的 122 例 p-T1aN0M0 腺癌患者，这些患者根据第 7 版 TNM 分期重新分类。根据以下临床病理参数将患者分为两组：年龄，<70 岁与>70 岁；性别，男性与女性；术前血清癌胚抗原（CEA）水平，<5.0ng/dl 与≥5.0ng/dl；肿瘤大小，<10mm 与>10mm；肿瘤内血管或淋巴管侵犯，阳性与阴性。对无病生存进行单因素和多因素分析。
中位随访时间为 41.4 个月。单因素分析显示，年龄、CEA 升高和肿瘤内血管或淋巴管侵犯等预后因素具有显著意义（年龄，<70 岁与>70 岁；97.1%与 82.0%，P=0.0027；术前血清 CEA 水平，<5.0ng/dl 与≥5.0ng/dl；93.3%与 33.3%，P<0.0001；肿瘤内血管或淋巴管侵犯，阳性与阴性；31.3%与 96.5%，P<0.0001）。多因素分析表明，只有肿瘤内血管或淋巴管侵犯是一个显著的独立预后因素（P=0.0039，风险比，0.066；95%置信区间，0.011-0.419）。
应始终研究并纳入肿瘤内血管或淋巴管侵犯的情况，并将其纳入最终的病理报告，以考虑其潜在的临床和治疗相关性。还应在临床试验中评估这些患者辅助化疗的疗效。
