*H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; †Department of Surgery, Memoral Sloan Kettering Cancer Center, New York, NY; ‡Department of Surgery, Albany Medical Center, Albany, NY; §Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France; ║Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy; ¶Yedikule Hospital for Chest Disease and Thoracic Surgery, Istanbul, Turkey; **Department of Surgery, University of Alabama at Birmingham, Birmingham, AL; and ††Department of Thoracic Oncology, H. Lee Moffitt Cancer Center, Tampa, FL.
J Thorac Oncol. 2015 Feb;10(2):338-45. doi: 10.1097/JTO.0000000000000400.
In the absence of metastatic disease, surgery for synchronous non-small-cell lung cancers involving multiple lobes can be curative. However, there currently exists no reliable prognostic instrument for this patient population after surgery. We undertook an analysis to examine the prognostic significance of adenocarcinoma histology and developed a prognostic nomogram.
This study was a pooled analysis of six previously reported datasets. Patients without extra-thoracic metastasis who underwent surgical resection of synchronous lung cancers in multiple lobes were included. Those with small cell cancer, carcinoid tumor, or exclusively carcinoma in situ were excluded. A multivariable Cox proportional hazards regression model was fitted to identify independent survival predictors for nomogram development.
Data from 467 patients were analyzed. Adenocarcinoma was a sole histology in 253 patients (54.2%). Those with exclusively adenocarcinoma histology had a better median survival than their counterparts: 67.4 versus 36.2 months, (p < 0.001). Multivariable analysis incorporating histology, sex, age, maximal T-size, highest N-stage, and laterality demonstrated that having exclusively adenocarcinoma histology independently predicted an improved survival: hazard ratio 0.61 (95% confidence interval: 0.48, 0.78). Other favorable survival predictors were N0, T-size less than or equal to 3 cm, bilateral cancers, age less than 70 years, and women sex. The developed nomogram was well calibrated and demonstrated a moderate to good discrimination with a bootstrap-corrected Harrell C-statistic of 0.70.
Several unique features among patients with resected synchronous multiple lung cancers, including the presence of exclusively adenocarcinoma histology, are of prognostic significance. A simple nomogram incorporating these factors can be utilized to predict patient survival with acceptable accuracy.
在没有转移病灶的情况下，对于多叶同时性非小细胞肺癌，手术可能是一种治愈性治疗。然而，目前对于此类患者手术后，尚无可靠的预后评估工具。我们进行了一项分析，旨在研究腺癌组织学的预后意义，并开发了一个预后列线图。
本研究是对六个先前报道的数据集进行的汇总分析。纳入了接受多叶同时性肺癌切除术且无胸外转移的患者。排除小细胞癌、类癌肿瘤或单纯原位癌患者。使用多变量 Cox 比例风险回归模型来确定用于列线图开发的独立生存预测因素。
共分析了 467 例患者的数据。253 例（54.2%）患者仅有腺癌组织学。仅有腺癌组织学的患者中位生存期优于其他患者：67.4 个月与 36.2 个月，（p<0.001）。纳入组织学、性别、年龄、最大 T 分期、最高 N 分期和侧别后多变量分析显示，仅有腺癌组织学独立地预测了更好的生存：风险比 0.61（95%置信区间：0.48，0.78）。其他有利的生存预测因素包括 N0、T 分期小于或等于 3cm、双侧癌症、年龄小于 70 岁和女性。所开发的列线图具有良好的校准度，Bootstrap 校正后的 Harrell C 统计量为 0.70，表明具有中等至良好的区分度。
对于接受多叶同时性肺癌切除术的患者，包括仅有腺癌组织学的患者，存在一些独特的特征，具有预后意义。一个简单的列线图，纳入这些因素，可以用于预测患者的生存，具有可接受的准确性。
