*Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan; †Department of General Thoracic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan; and ‡Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
J Thorac Oncol. 2015 Apr;10(4):619-28. doi: 10.1097/JTO.0000000000000480.
Some unfavorable prognostic factors for stage I non-small-cell lung cancers have been reported; however, they are not reflected in the current Tumor-Node-Metastasis classification.
We retrospectively reviewed 629 patients who underwent complete resection of pathological stage I adenocarcinomas (ADs) or squamous cell carcinomas (SQs) at two institutes between 1996 and 2011. The correlation between clinicopathological characteristics and survival rates was analyzed to identify prognostic factors.
Multivariate analysis indicated that among ADs, high serum carcinoembryonic antigen levels (p = 0.04 for overall survival [OS]; p < 0.01 for recurrence-free survival [RFS]; p = 0.02 for disease-specific survival [DSS]), lymphatic permeation (p < 0.01 for RFS and DSS), and vascular invasion (p < 0.01 for OS and RFS; p = 0.03 for DSS) were independent prognostic factors. Among SQs, high squamous cell carcinoma antigen (SCC) (p < 0.05 for OS), and vascular invasion (p < 0.05 for RFS and DSS) were independently prognostic. We suggest that among completely resected tumors less than or equal to 5 cm without lymph node metastasis, the current stages IA and IB AD with high serum carcinoembryonic antigen levels, lymphatic permeation, or vascular invasion should be upgraded to stage IB and IIA, respectively. The current stage IA SQ with high SCC antigen levels or vascular invasion should be upgraded to stage IB. These reclassifications accurately reflect survival status (p < 0.04 in all comparisons).
Some important differences in prognostic factors were observed between AD and SQ. High preoperative serum tumor marker levels and lymphovascular invasion should be included as additional criteria in the forthcoming Tumor-Node-Metastasis staging.
已有研究报道了一些对Ⅰ期非小细胞肺癌预后不利的因素，但这些因素并未反映在目前的肿瘤-淋巴结-转移（TNM）分期中。
我们回顾性分析了 1996 年至 2011 年间在两个研究所接受完全切除病理Ⅰ期腺癌（AD）或鳞癌（SQ）的 629 例患者。分析了临床病理特征与生存率的相关性，以确定预后因素。
多变量分析表明，在 AD 中，高血清癌胚抗原水平（总生存[OS]：p=0.04；无复发生存[RFS]：p<0.01；疾病特异性生存[DSS]：p=0.02）、淋巴管浸润（RFS 和 DSS：p<0.01）和血管浸润（OS 和 RFS：p<0.01；DSS：p=0.03）是独立的预后因素。在 SQ 中，高鳞状细胞癌抗原（SCC）（OS：p<0.05）和血管浸润（RFS 和 DSS：p<0.05）是独立的预后因素。我们建议，在完全切除的、直径小于或等于 5cm 且无淋巴结转移的肿瘤中，当前的ⅠA 期和 IB 期 AD 患者，若血清癌胚抗原水平升高、淋巴管浸润或血管浸润，应分别升级为 IB 期和ⅡA 期。当前的ⅠA 期 SCC 抗原水平升高或有血管浸润的 SQ 应升级为 IB 期。这些重新分类准确地反映了生存状况（所有比较均 p<0.04）。
在 AD 和 SQ 之间观察到一些预后因素的重要差异。术前高血清肿瘤标志物水平和脉管浸润应作为附加标准纳入即将到来的 TNM 分期中。
