Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología (FIVO), Valencia, España.
Servicio de Cirugía Torácica, Hospital Universitario y Politécnico La Fe, Valencia, España.
Arch Bronconeumol. 2015 Sep;51(9):431-9. doi: 10.1016/j.arbres.2014.11.014. Epub 2015 Jan 14.
In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival.
A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤3cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results.
Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1>60%, number of resected nodes>7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor "age<50 years" was close to the margin of statistical significance. Pleural invasion and vascular invasion were entered in the multivariate analysis. The competing-risk analysis showed a probability of death due to cancer of 14.3 and 35.1% at 5 and 10 years, respectively. Significant variables in the univariate and multivariate analyses were similar, with the exception of FEV1>60%.
Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤3cm and can be used for generating a predictive risk model.
在 TNM 分类中，非小细胞肺癌肿瘤（T）成分的决定因素几乎没有随时间变化，仍然仅基于解剖特征。我们的目的是研究这些和其他形态病理学因素对生存的影响。
研究了 263 例因直径≤3cm 的 I 期非小细胞肺癌接受肺切除术的患者。根据临床、手术和病理变量，使用生存分析和竞争风险估计研究，分别使用 actuarial 分析和累积发生率方法进行生存分析和竞争风险估计研究。然后根据结果生成风险模型。
5 年和 10 年的生存率分别为 79.8%和 74.3%。最佳预后因素是存在症状、吸烟习惯和 FEV1>60%、切除的淋巴结数>7、鳞状组织学、无血管侵犯、无内脏胸膜侵犯以及近端侵犯超过叶支气管。根据 actuarial 方法，所有这些因素均具有统计学意义。“年龄<50 岁”是接近统计学意义的边缘因素。胸膜侵犯和血管侵犯进入多变量分析。竞争风险分析显示，5 年和 10 年因非小细胞肺癌死亡的概率分别为 14.3%和 35.1%。单变量和多变量分析中的显著变量相似，除了 FEV1>60%。
胸膜侵犯和血管侵犯决定了≤3cm 的非小细胞肺癌的生存或因非小细胞肺癌死亡的风险，可用于生成预测风险模型。
