Ye Wen-Feng, Xie Xuan, Yang Hong, Luo Kong-Jia, Liu Qian-Wen, Zheng Yu-Zhen, Wang Jun-Ye
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
Department of Clinical Nutrition, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
Chin J Cancer. 2016 Jan 6;35:7. doi: 10.1186/s40880-015-0069-8.
Despite numerous previous studies, the consideration of tumor location as a prognostic factor in resectable non-small cell lung cancer (NSCLC) remains controversial. The present study analyzed the association between tumor location and clinical outcome in patients with resectable NSCLC who had undergone lobectomy with systematic lymphadenectomy and who had presented with varying nodal statuses.
The data from a cohort of 627 eligible patients treated in Sun Yat-sen University Cancer Center between January 2000 and December 2008 were retrospectively collected, and the nodal statuses of patients with different tumor locations were compared. Cox proportional hazards regression model was used to determine the independent factors related to cancer-specific survival (CSS).
Multivariate analysis demonstrated that left lower lobe (LLL) tumors [hazard ratio (HR): 1.465, 95% confidence interval (CI) 1.090-1.969, P = 0.011], lymph node metastasis (HR: 2.742, 95% CI 2.145-3.507, P < 0.001), and a tumor size of >4 cm (HR: 1.474, 95% CI 1.151-1.888, P = 0.002) were three independent prognosticators in patients with resectable NSCLC. However, LLL tumors were associated only with CSS in node-positive patients (HR: 1.528, 95% CI 1.015-2.301, P = 0.042), and a tumor size of >4 cm was the only independent risk predictor in the node-negative subgroup (HR: 1.889, 95% CI 1.324-2.696, P < 0.001).
Tumor location is related to the long-term CSS of NSCLC patients with lymph node metastasis. LLL tumors may be upstaged in node-positive patients to facilitate an optimal treatment strategy.
尽管此前有众多研究，但在可切除的非小细胞肺癌（NSCLC）中，将肿瘤位置视为预后因素仍存在争议。本研究分析了接受肺叶切除及系统性淋巴结清扫且淋巴结状态各异的可切除NSCLC患者的肿瘤位置与临床结局之间的关联。
回顾性收集了2000年1月至2008年12月在中山大学肿瘤防治中心接受治疗的627例符合条件患者的数据，并比较了不同肿瘤位置患者的淋巴结状态。采用Cox比例风险回归模型确定与癌症特异性生存（CSS）相关的独立因素。
多因素分析表明，左下叶（LLL）肿瘤[风险比（HR）：1.465，95%置信区间（CI）1.090 - 1.969，P = 0.011]、淋巴结转移（HR：2.742，95% CI 2.145 - 3.507，P < 0.001）以及肿瘤大小>4 cm（HR：1.474，95% CI 1.151 - 1.888，P = 0.002）是可切除NSCLC患者的三个独立预后因素。然而，LLL肿瘤仅与淋巴结阳性患者的CSS相关（HR：1.528，95% CI 1.015 - 2.301，P = 0.042），而肿瘤大小>4 cm是淋巴结阴性亚组中唯一的独立风险预测因素（HR：1.889，95% CI 1.324 - 2.696，P < 0.001）。
肿瘤位置与有淋巴结转移的NSCLC患者的长期CSS相关。在淋巴结阳性患者中，LLL肿瘤可能被上调分期，以利于制定最佳治疗策略。
