术前阻塞性肺炎或肺不张对非小细胞肺癌的预后影响及其与肿瘤大小的比较
Prognostic effects of preoperative obstructive pneumonitis or atelectasis and comparison with tumor size in non-small cell lung cancer.
作者信息
Pang Zhaofei, Ding Nan, Dong Wei, Ni Yang, Zhang Tiehong, Qu Xiao, Du Jiajun, Liu Qi
机构信息
Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
出版信息
J Thorac Dis. 2017 Mar;9(3):768-778. doi: 10.21037/jtd.2017.02.88.
BACKGROUND
In the eighth TNM staging system proposal, lung cancer with part or complete obstructive pneumonitis/atelectasis was classified to T2 category, and dividing lines of T category were changed. We conducted this study to search prognostic effect of preoperative obstructive pneumonitis/atelectasis and its comparison with tumor size.
METHODS
We collected clinical characteristics, preoperative hematological indicators, follow-up information of 1,313 lung cancer patients. Chi-square test was used to search relationship between obstruction pneumonitis/atelectasis and other factors. Kaplan-Meier (K-M) curves and cox regression methods were used for survival analysis.
RESULTS
Preoperative obstructive pneumonitis/atelectasis indicated shorter OS (HR: 1.308; 95% CI: 1.058-1.619) and RFS (HR: 1.276; 95% CI: 1.032-1.579) as an independent factor. In comparison with tumor size, we found patients with obstructive pneumonitis/atelectasis and T1 size tumor had similar prognosis to those with T2 size but without obstructive pneumonitis/atelectasis, and OS, RFS of patients with obstructive pneumonitis/atelectasis and T2 size were significantly shorter than those with T2 tumor size but without obstructive pneumonitis/atelectasis, while similar to patients with T3 tumor size but without obstructive pneumonitis/atelectasis according to division by the eighth edition. We also found obstructive pneumonitis/atelectasis was significantly related to higher neutrophil (P<0.001), platelet (P<0.001), monocyte (P<0.001), NLR (P<0.001), PLR (P=0.002), ESR (P<0.001) and lower LMR (P<0.001).
CONCLUSIONS
Preoperative obstructive pneumonitis/atelectasis predicted poor survival independently in non-small cell lung cancer (NSCLC). And we suggested which T staging group the patients with obstructive pneumonitis/atelectasis would be divided to should depend on tumor size in the eighth TNM staging system.
背景
在第八版TNM分期系统提案中，伴有部分或完全阻塞性肺炎/肺不张的肺癌被归类为T2期，T分期的分界线发生了变化。我们开展本研究以探寻术前阻塞性肺炎/肺不张的预后影响及其与肿瘤大小的比较。
方法
我们收集了1313例肺癌患者的临床特征、术前血液学指标及随访信息。采用卡方检验探寻阻塞性肺炎/肺不张与其他因素之间的关系。采用Kaplan-Meier（K-M）曲线和Cox回归方法进行生存分析。
结果
术前阻塞性肺炎/肺不张作为独立因素表明总生存期（HR：1.308；95%CI：1.058 - 1.619）和无复发生存期（HR：1.276；95%CI：1.032 - 1.579）较短。与肿瘤大小相比，我们发现伴有阻塞性肺炎/肺不张的T1期肿瘤患者的预后与不伴有阻塞性肺炎/肺不张的T2期肿瘤患者相似，且伴有阻塞性肺炎/肺不张的T2期患者的总生存期和无复发生存期显著短于不伴有阻塞性肺炎/肺不张的T2期肿瘤患者，而根据第八版分期，其与不伴有阻塞性肺炎/肺不张的T3期肿瘤患者相似。我们还发现阻塞性肺炎/肺不张与较高的中性粒细胞（P<0.001）、血小板（P<0.001）、单核细胞（P<0.001）、中性粒细胞与淋巴细胞比值（P<0.001）、血小板与淋巴细胞比值（P = 0.002）、红细胞沉降率（P<0.001）显著相关，与较低的淋巴细胞与单核细胞比值（P<0.001）显著相关。
结论
术前阻塞性肺炎/肺不张可独立预测非小细胞肺癌（NSCLC）患者的不良生存。并且我们建议在第八版TNM分期系统中，伴有阻塞性肺炎/肺不张的患者应划分至哪个T分期组应取决于肿瘤大小。
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