伴有肺空洞形成的病理I期非小细胞肺癌患者根治性切除术后生存率较差。
Worse survival after curative resection in patients with pathological stage I non-small cell lung cancer adjoining pulmonary cavity formation.
作者信息
Kimura Hiroyuki, Saji Hisashi, Miyazawa Tomoyuki, Sakai Hiroki, Tsuda Masataka, Wakiyama Yoichi, Marushima Hideki, Kojima Koji, Nakamura Haruhiko
机构信息
Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan.
出版信息
J Thorac Dis. 2017 Sep;9(9):3038-3044. doi: 10.21037/jtd.2017.08.42.
BACKGROUND
A few investigators have suggested an association between lung cancer and pulmonary cavity. However, this clinical association and its carcinogenic correlations are not well recognized. This study aimed to clarify the clinical features and to demonstrate the associated survival outcomes after curative surgery in patients with early non-small cell lung cancer (NSCLC) adjoining pulmonary cavity formation.
METHODS
We retrospectively reviewed 275 patients with pathological stage I NSCLC by re-evaluating their chest computed tomography images. Among them, we detected NSCLC adjoining pulmonary cavity formation in 12 (4.4%) patients.
RESULTS
The median follow-up period for all 275 patients was 43.2 (range, 6.0-86.0) months. Of these patients, 6 (50.0%) in group CF (patients with NSCLC adjoining pulmonary cavity formation) and 19 (7.2%) in group C (the control group, n=263) died during the study period. Besides, 6 (50.0%) and 32 (12.2%) patients in groups CF and C, respectively, exhibited recurrence of the primary lung cancer. The cumulative overall survival (OS) in groups CF and C at 5 years was 37.0% and 91.7%, respectively (P<0.0001); the recurrence-free survival (RFS) in these groups at 5 years was 55.0% and 86.7%, respectively (P=0.001). Univariate analysis showed that male sex, smoking habits, non-adenocarcinoma, and presence of pulmonary cavity formation were associated with poor OS (P=0.008, P=0.001, P<0.0001, and P<0.0001, respectively). Multivariate analysis demonstrated that smoking, non-adenocarcinoma, and pulmonary cavity formation were independent prognostic factors predicting poor survival (P=0.043, P=0.004 and P<0.0001, respectively).
CONCLUSIONS
Our results suggest that patients with early-stage NSCLC adjoining pulmonary cavity formation have an increased risk of poor OS and RFS after surgical resection. Further prospective, multi-institutional investigations and substantial clinical studies are warranted.
背景
一些研究者提出肺癌与肺空洞之间存在关联。然而，这种临床关联及其致癌相关性尚未得到充分认识。本研究旨在阐明早期非小细胞肺癌（NSCLC）合并肺空洞形成患者在根治性手术后的临床特征，并展示相关的生存结果。
方法
我们通过重新评估275例病理分期为I期NSCLC患者的胸部计算机断层扫描图像进行回顾性研究。其中，我们检测到12例（4.4%）患者的NSCLC合并肺空洞形成。
结果
所有275例患者的中位随访期为43.2（范围6.0 - 86.0）个月。在这些患者中，CF组（NSCLC合并肺空洞形成的患者）有6例（50.0%）死亡，C组（对照组，n = 263）有19例（7.2%）在研究期间死亡。此外，CF组和C组分别有6例（50.0%）和32例（12.2%）患者出现原发性肺癌复发。CF组和C组5年时的累积总生存率（OS）分别为37.0%和91.7%（P < 0.0001）；这些组5年时的无复发生存率（RFS）分别为55.0%和86.7%（P = 0.001）。单因素分析显示，男性、吸烟习惯、非腺癌以及肺空洞形成与较差的OS相关（分别为P = 0.008、P = 0.001、P < 0.0001和P < 0.0001）。多因素分析表明，吸烟、非腺癌和肺空洞形成是预测生存不良的独立预后因素（分别为P = 0.043、P = 0.004和P < 0.0001）。
结论
我们的结果表明，早期NSCLC合并肺空洞形成的患者在手术切除后OS和RFS较差风险增加。有必要进行进一步的前瞻性、多机构研究和大量临床研究。
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