淋巴血管侵犯在临床淋巴结阴性和病理淋巴结阳性肺腺癌患者预后中的作用。

Role of lymphatic invasion in the prognosis of patients with clinical node-negative and pathologic node-positive lung adenocarcinoma.

机构信息

Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.

Department of Pathology, Hiroshima University, Hiroshima, Japan.

出版信息

J Thorac Cardiovasc Surg. 2014 Jun;147(6):1820-6. doi: 10.1016/j.jtcvs.2013.11.050. Epub 2013 Dec 31.

DOI:10.1016/j.jtcvs.2013.11.050

PMID:24507979

Abstract

OBJECTIVE

Some patients with clinical T1 N0 M0 lung adenocarcinoma have pathologic lymph node metastasis. However, neither the precise prognosis nor the factors predictive of the prognosis of such patients have yet been identified.

METHODS

Our study included 609 patients with clinical T1 N0 M0 lung adenocarcinoma; 568 (93.3%) pathologic node negative [pN(-)] and 41 (6.7%) pathologic node positive [pN(+)] patients, diagnosed after complete surgical resection. The association between prognosis and pathologic findings was analyzed retrospectively.

RESULTS

pN(+) patients had a significantly lower lepidic growth component ratio (10% vs 50%), a higher lymphatic invasion (LI) rate (68% vs 11%), vessel invasion rate (59% vs 14%), and visceral pleural invasion rate (29% vs 9%), compared with pN(-) patients (all Ps < .001). Surprisingly, 13 of 41 (32%) pN(+) patients showed no LI. In pN(-) patients, a multivariate analysis of recurrence-free survival revealed that lower lepidic growth component ratio, and lymphatic, vessel, and pleural invasion were significantly correlated with a poor prognosis (P = .008, .045, .031, and .024). However, in pN(+) patients, the multivariate analysis of recurrence-free survival showed that only LI was a significant independent prognostic factor (P = .037). The 5-year recurrence-free survival rates were as follows: 91.2% for pN(-)/LI(-) patients, 68.2% for pN(-)/LI(+) patients, 63.5% for pN(+)/LI(-) patients, and 41.9% for pN(+)/LI(+) patients. LI status stratified the prognosis not only in patients with no nodal metastasis but also in those with metastasis.

CONCLUSIONS

LI, which is not always present in node-positive adenocarcinoma, is an important prognostic variable in patients with node involvement.

摘要

目的

部分临床 T1N0M0 期肺腺癌患者存在病理淋巴结转移。然而，目前尚未明确此类患者的精确预后及其预后的预测因素。

方法

本研究纳入 609 例临床 T1N0M0 期肺腺癌患者，其中 568 例（93.3%）为病理淋巴结阴性（pN(-)），41 例（6.7%）为病理淋巴结阳性（pN(+)），所有患者均经完全手术切除后确诊。回顾性分析预后与病理发现之间的关系。

结果

与 pN(-)患者相比，pN(+)患者的贴壁生长成分比例（10%比 50%）明显较低，淋巴管浸润（LI）率（68%比 11%）、脉管浸润率（59%比 14%）和脏层胸膜侵犯率（29%比 9%）较高（均 P<0.001）。令人惊讶的是，41 例 pN(+)患者中有 13 例无 LI。在 pN(-)患者中，多变量分析显示，贴壁生长成分比例较低、存在淋巴管、脉管和胸膜浸润与预后不良显著相关（P=0.008、0.045、0.031 和 0.024）。然而，在 pN(+)患者中，多变量分析显示仅 LI 是独立的预后不良的显著预测因素（P=0.037）。5 年无复发生存率如下：pN(-)/LI(-)患者为 91.2%，pN(-)/LI(+)患者为 68.2%，pN(+)/LI(-)患者为 63.5%，pN(+)/LI(+)患者为 41.9%。LI 状态不仅在无淋巴结转移的患者中分层预后，而且在有淋巴结转移的患者中也分层预后。