Wang Yiyang, Wang Rui, Zheng Difan, Han Baohui, Zhang Jie, Zhao Heng, Luo Jizhuang, Zheng Jiajie, Chen Tianxiang, Huang Qingyuan, Sun Yihua, Chen Haiquan
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
J Cancer Res Clin Oncol. 2017 Jun;143(6):1043-1051. doi: 10.1007/s00432-016-2337-7. Epub 2017 Feb 15.
This study was designed to investigate the risk factors of recurrence and survival of clinical stage I lung adenocarcinoma underwent wedge resection by the use of Shanghai Chest Hospital Lung Cancer Database.
A total of 746 patients with clinical stage I adenocarcinoma underwent wedge resection from 2010 to 2015 in our database were included in this study. Univariable and multivariable Cox proportional hazards regression were performed successively to select significant risk factors and then nomograms as well as the concordance indexes for RFS, OS and LCSS were developed, respectively. Kaplan-Meier survival curves were performed if necessary, with the identification of log-rank test.
The 5-year RFS, OS and LCSS of clinical stage I adenocarcinoma underwent wedge resection were 86.1, 83.6 and 85.2%, respectively. There were three independent risk factors related with RFS (sex, pathology, pleural invasion), two related with OS (sex, volume ratio) and two with LCSS (sex, volume ratio) with the analysis of Cox regression and were selected to develop nomograms. The C-indexes of RFS, OS and LCSS were 0.767 (95% CI 0.667-0.867), 0.782 (95% CI 0.660-0.904) and 0.794 (95% CI 0.669-0.919), respectively. Lymphadenectomy did not show differences statistically but had tendencies of better RFS, OS and LCSS among the subgroup of invasive adenocarcinoma.
Sex, pathology and pleural invasion could be recommended as criteria for clinical stage I adenocarcinoma undergoing wedge resection. And the larger the wedge volume and/or the smaller the tumor volume was, the better OS and LCSS were. If the volume ratio reached 10:1 or more, the survival rate was approximately 90% for both OS and LCSS. Whether lymphadenectomy was necessary for WR, especially in invasive adenocarcinoma, needed further research.
本研究旨在利用上海胸科医院肺癌数据库，调查接受楔形切除术的临床I期肺腺癌复发和生存的危险因素。
本研究纳入了2010年至2015年在我们数据库中接受楔形切除术的746例临床I期腺癌患者。先后进行单变量和多变量Cox比例风险回归以选择显著危险因素，然后分别绘制列线图以及计算无复发生存期（RFS）、总生存期（OS）和肺癌特异性生存期（LCSS）的一致性指数。必要时绘制Kaplan-Meier生存曲线，并进行对数秩检验。
接受楔形切除术的临床I期腺癌的5年RFS、OS和LCSS分别为86.1%、83.6%和85.2%。通过Cox回归分析，有三个与RFS相关的独立危险因素（性别、病理、胸膜侵犯），两个与OS相关（性别、体积比），两个与LCSS相关（性别、体积比），并据此绘制列线图。RFS、OS和LCSS的C指数分别为0.767（95%CI 0.667-0.867）、0.782（95%CI 0.660-0.904）和0.794（95%CI 0.669-0.919）。淋巴结清扫术在统计学上无差异，但在浸润性腺癌亚组中，有RFS、OS和LCSS更好的趋势。
对于接受楔形切除术的临床I期腺癌，可推荐将性别、病理和胸膜侵犯作为标准。楔形体积越大和/或肿瘤体积越小，OS和LCSS越好。如果体积比达到10:1或更高，OS和LCSS的生存率均约为90%。对于楔形切除术是否有必要进行淋巴结清扫，尤其是浸润性腺癌，需要进一步研究。
