Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Republic of China.
Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Republic of China; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Republic of China.
J Thorac Oncol. 2017 Dec;12(12):1824-1833. doi: 10.1016/j.jtho.2017.07.009. Epub 2017 Jul 21.
The role of adjuvant chemotherapy for patients with stage I NSCLC remains unknown. The prognostic value of histological subtypes in resected node-negative small lung adenocarcinoma has not been widely investigated. This study investigated the prognostic factors in patients with node-negative lung adenocarcinoma 3 cm or smaller to find potential candidates for adjuvant chemotherapy.
A total of 726 patients with completely resected node-negative lung adenocarcinoma 3 cm or smaller were included in the study. Prognostic factors for overall survival or probability of freedom from recurrence (FFR) were investigated.
During follow-up, recurrence developed in 59 patients (8.1%). Univariate analysis showed that the micropapillary/solid predominant pattern group was associated with a significantly lower probability of FFR (p = 0.001) in node-negative lung adenocarcinoma 3 cm or smaller. Those with greater tumor size (p = 0.001) and the micropapillary/solid predominant pattern group (p = 0.035) had a significantly lower probability of FFR in multivariate analysis. For tumors 2 cm or smaller, the micropapillary/solid predominant pattern group had a trend toward a lower probability of FFR (p = 0.053) in multivariate analysis. Presence of the solid pattern was a prognostic factor for lower probability of FFR (p = 0.001) in multivariate analysis.
The new adenocarcinoma classification has significant impact on recurrence in node-negative lung adenocarcinoma 3 cm or smaller. Patients with the micropapillary/solid predominant pattern have a significantly higher risk for recurrence. For tumors 2 cm or smaller, presence of the solid pattern was a prognostic factor for higher probability of recurrence. This information is useful for patient stratification for adjuvant therapy.
对于 I 期 NSCLC 患者，辅助化疗的作用仍不清楚。在未发生淋巴结转移的小肺腺癌中，组织学亚型的预后价值尚未得到广泛研究。本研究旨在探讨淋巴结阴性小肺腺癌（直径≤3cm）患者的预后因素，以期为辅助化疗提供潜在的候选人群。
本研究共纳入 726 例完全切除的淋巴结阴性小肺腺癌（直径≤3cm）患者。对总生存期或无复发生存率（FFR）的预后因素进行了研究。
在随访期间，59 例患者（8.1%）出现复发。单因素分析显示，微乳头/实性为主型组的 FFR 显著降低（p=0.001）。多因素分析显示，肿瘤直径较大（p=0.001）和微乳头/实性为主型组（p=0.035）与 FFR 显著降低相关。对于直径≤2cm 的肿瘤，多因素分析显示，微乳头/实性为主型组 FFR 显著降低（p=0.053）。实性模式的存在是 FFR 降低的预后因素（p=0.001）。
新的腺癌分类对淋巴结阴性小肺腺癌（直径≤3cm）的复发有显著影响。微乳头/实性为主型患者的复发风险显著增加。对于直径≤2cm 的肿瘤，实性模式的存在是复发概率较高的预后因素。这些信息对辅助治疗的患者分层有一定的指导作用。
