肺浸润性腺癌与肺上叶区域相关。
Invasive adenocarcinoma of the lung is associated with the upper lung regions.
作者信息
Kinsey C Matthew, Estepar Raul San Jose, Zhao Yang, Yu Xiaojin, Diao Nancy, Heist Rebecca Suk, Wain John C, Mark Eugene J, Washko George, Christiani David C
机构信息
Division of Pulmonary and Critical Care, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington VT 05405, United States.
Department of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
出版信息
Lung Cancer. 2014 May;84(2):145-50. doi: 10.1016/j.lungcan.2014.02.002. Epub 2014 Feb 11.
OBJECTIVES
We postulated that ventilation-perfusion (V/Q) relationships within the lung might influence where lung cancer occurs. To address this hypothesis we evaluated the location of lung adenocarcinoma, by both tumor lobe and superior-inferior regional distribution, and associated variables such as emphysema.
MATERIALS AND METHODS
One hundred fifty-nine cases of invasive adenocarcinoma and adenocarcinoma with lepidic features were visually evaluated to identify lobar or regional tumor location. Regions were determined by automated division of the lungs into three equal volumes: (upper region, middle region, or lower region). Automated densitometry was used to measure radiographic emphysema.
RESULTS
The majority of invasive adenocarcinomas occurred in the upper lobes (69%), with 94% of upper lobe adenocarcinomas occurring in the upper region of the lung. The distribution of adenocarcinoma, when classified as upper or lower lobe, was not different between invasive adenocarcinoma and adenocarcinoma with lepidic features (formerly bronchioloalveolar cell carcinoma, P = 0.08). Regional distribution of tumor was significantly different between invasive adenocarcinoma and adenocarcinoma with lepidic features (P = 0.001). Logistic regression analysis with the outcome of invasive adenocarcinoma histology was used to adjust for confounders. Tumor region continued to be a significant predictor (OR 8.5, P = 0.008, compared to lower region), whereas lobar location of tumor was not (P = 0.09). In stratified analysis, smoking was not associated with region of invasive adenocarcinoma occurrence (P = 0.089). There was no difference in total emphysema scores between invasive adenocarcinoma cases occurring in each of the three regions (P = 0.155). There was also no difference in the distribution of region of adenocarcinoma occurrence between quartiles of emphysema (P = 0.217).
CONCLUSION
Invasive adenocarcinoma of the lung is highly associated with the upper lung regions. This association is not related to smoking, history of COPD, or total emphysema. The regional distribution of invasive adenocarcinoma may be due to V/Q relationships or other local factors.
目的
我们推测肺内通气-灌注（V/Q）关系可能会影响肺癌的发生部位。为验证这一假设，我们通过肿瘤所在肺叶及上下区域分布情况评估肺腺癌的位置，并分析与之相关的变量，如肺气肿。
材料与方法
对159例浸润性腺癌及具有鳞屑样特征的腺癌进行视觉评估，以确定肿瘤所在的肺叶或区域位置。通过将肺自动划分为三个等体积区域（上区域、中区域或下区域）来确定各区域。采用自动密度测定法测量影像学肺气肿。
结果
大多数浸润性腺癌发生在上叶（69%），其中94%的上叶腺癌发生在肺的上区域。按上叶或下叶分类时，浸润性腺癌与具有鳞屑样特征的腺癌（原细支气管肺泡癌）的腺癌分布无差异（P = 0.08）。浸润性腺癌与具有鳞屑样特征的腺癌的肿瘤区域分布存在显著差异（P = 0.001）。采用浸润性腺癌组织学结果进行逻辑回归分析以校正混杂因素。肿瘤区域仍是一个显著的预测因素（与下区域相比，OR 8.5，P = 0.008），而肿瘤所在肺叶位置则不然（P = 0.09）。在分层分析中，吸烟与浸润性腺癌发生区域无关（P = 0.089）。在三个区域中发生的浸润性腺癌病例的总肺气肿评分无差异（P = 0.155）。肺气肿四分位数之间腺癌发生区域的分布也无差异（P = 0.217）。
结论
肺浸润性腺癌与肺上区域高度相关。这种关联与吸烟、慢性阻塞性肺疾病史或总肺气肿无关。浸润性腺癌的区域分布可能归因于V/Q关系或其他局部因素。
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