Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
J Thorac Cardiovasc Surg. 2018 Mar;155(3):1227-1235.e2. doi: 10.1016/j.jtcvs.2017.09.143. Epub 2017 Nov 7.
To evaluate the prognostic significance and beneficiaries of adjuvant chemotherapy (ACT) in various histological patterns of stage IB lung adenocarcinoma according to the 8th tumor-node-metastasis (TNM) classification.
A total of 1131 patients with pathological stage IB lung adenocarcinoma according to the 8th TNM classification who underwent lobectomy or segmentectomy were enrolled in this study. Based on the proportion of solid/micropapillary components, the patients were classified into 3 groups: solid/micropapillary-negative (SMPN) (n = 719; median survival, 49.7 months; interquartile range [IQR]. 35.1-67.0 months), solid/micropapillary-minor (SMPM; >5% but not predominant) (n = 272; median survival, 38.8 months; IQR, 26.6-51.5 months) and solid/micropapillary-predominant (SMPP; >5% and the most dominant) (n = 140; median survival, 39.6 months; IQR, 26.8-52.5 months). The predictors of disease-specific survival and recurrence-free survival were investigated. To reduce selection bias, propensity score-matching analysis was implemented before survival data were compared.
Our data show significant differences in survival rates based on the proportion of solid/micropapillary patterns. The SMPM group had significantly higher cumulative incidences of lung cancer-specific death (P = .000) and recurrence (P = .000) compared with the SMPN group, so did the SMPP group when compared with SMPM patients (P = .000 for both). Multivariate analysis showed that the SMPM and SMPP patterns were poor prognostic factors for disease-specific survival (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.12-3.09 and HR, 4.56; 95% CI, 2.69-7.71, respectively) and recurrence-free survival (HR, 1.64; 95% CI, 1.20-2.24 and HR, 2.43; 95% CI, 1.64-3.60, respectively), as were older age, male sex, smoking history, larger tumor size, necrosis, and abnormal pulmonary function. Survival analysis stratified by histological pattern showed that patients with the SMPP pattern who received ACT had obviously lower cumulative incidences of lung cancer-specific death (HR, 0.46; 95% CI, 0.22-0.93; P = .031) and recurrence (HR, 0.48; 95% CI, 0.26-0.88; P = .017).
Solid/micropapillary patterns were associated with poor prognosis, even if they were not predominant. ACT contributed to survival benefits in the SMPP subgroup of patients with stage IB lung adenocarcinoma.
根据第 8 版肿瘤-淋巴结-转移（TNM）分期，评估各组织学类型的 IB 期肺腺癌辅助化疗（ACT）的预后意义和获益人群。
共纳入 1131 例经病理分期为 IB 期肺腺癌且接受肺叶切除术或肺段切除术的患者。根据实体/微乳头成分的比例，将患者分为 3 组：实体/微乳头阴性（SMPN）组（n=719；中位生存时间 49.7 个月；四分位间距[IQR]35.1-67.0 个月）、实体/微乳头非主要（SMPM）组（＞5%但非主要成分，n=272；中位生存时间 38.8 个月；IQR 26.6-51.5 个月）和实体/微乳头主要（SMPP）组（＞5%且为最主要成分，n=140；中位生存时间 39.6 个月；IQR 26.8-52.5 个月）。分析疾病特异性生存和无复发生存的预测因素。为了减少选择偏倚，在比较生存数据之前进行了倾向评分匹配分析。
我们的数据显示，基于实体/微乳头模式的比例，生存率存在显著差异。SMPM 组的肺癌特异性死亡（P=0.000）和复发（P=0.000）累积发生率明显更高，SMPP 组与 SMPM 组相比也是如此（两者均 P=0.000）。多因素分析显示，SMPM 和 SMPP 模式是疾病特异性生存（危险比[HR]1.86；95%置信区间[CI]1.12-3.09 和 HR 4.56；95%CI 2.69-7.71）和无复发生存（HR 1.64；95%CI 1.20-2.24 和 HR 2.43；95%CI 1.64-3.60）的不良预后因素，年龄较大、男性、吸烟史、肿瘤较大、坏死和肺功能异常也是如此。按组织学模式分层的生存分析显示，接受 ACT 的 SMPP 模式患者的肺癌特异性死亡（HR 0.46；95%CI 0.22-0.93；P=0.031）和复发（HR 0.48；95%CI 0.26-0.88；P=0.017）累积发生率明显较低。
即使实体/微乳头模式不是主要成分，也与预后不良相关。ACT 有助于 IB 期肺腺癌 SMPP 亚组患者的生存获益。
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