Tao Hiroyuki, Soh Junichi, Yamamoto Hiromasa, Fujiwara Toshiya, Ueno Tsuyoshi, Hayama Makio, Okazaki Mikio, Sugimoto Ryujiro, Yamashita Motohiro, Sano Yoshifumi, Okabe Kazunori, Matsuura Motoki, Kataoka Kazuhiko, Moriyama Shigeharu, Toyooka Shinichi, Miyoshi Shinichiro
Division of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.
Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
J Thorac Dis. 2017 Nov;9(11):4325-4335. doi: 10.21037/jtd.2017.10.70.
Patients with squamous cell carcinoma (SqCC) of the lung sometimes have a comorbid pulmonary disease such as pulmonary emphysema or an interstitial lung disease (ILD), both of which negatively affect patient outcome. The aim of this study was to determine the outcome of patients in a multicenter database who underwent surgery for cT1aN0M0 peripheral SqCC lung cancer.
The medical records of a total of 228 eligible patients from seven institutions were reviewed to evaluate the impact of concomitant impaired pulmonary function and other clinicopathological factors on overall survival (OS) and relapse-free survival (RFS).
Six patients with positive or unclear tumor margins were excluded. Of the 222 remaining study patients, 42 (18.9%) and 97 (43.7%) patients were found to have coexisting restrictive or obstructive ventilatory impairment, respectively. Over a median follow-up period of 30.6 months, the 5-year OS and RFS were 69.0% and 62.6%, respectively. By multivariate analysis, ILDs identified on high-resolution computed tomography (HRCT), pulmonary function test results indicating a restrictive ventilatory impairment, and wedge resection were found to be independent risk factors for poor OS. An increased level of serum squamous cell carcinoma antigen (SCC-Ag) (>1.5 ng/mL) and the same risk factors for poor OS were independent risk factors for recurrence. Among patients who underwent anatomical lung resection (lobectomy and segmentectomy, n=173), a restrictive ventilatory impairment was an independent risk factor for poor OS, and increased serum SCC-Ag level, ILDs on HRCT, and restrictive ventilatory impairment were independent risk factors for poor RFS by multivariate analysis. Factors such as visceral pleural invasion, and lymphatic or vascular invasion were not significantly associated with outcome.
A restrictive ventilatory impairment negatively affects the outcome of patients with cT1aN0M0 peripheral SqCC lung cancer.
肺鳞状细胞癌（SqCC）患者有时合并有肺部疾病，如肺气肿或间质性肺疾病（ILD），这两种疾病均会对患者的预后产生负面影响。本研究的目的是确定多中心数据库中接受cT1aN0M0周围型SqCC肺癌手术患者的预后情况。
回顾了来自7家机构的228例符合条件患者的病历，以评估合并的肺功能受损及其他临床病理因素对总生存期（OS）和无复发生存期（RFS）的影响。
6例肿瘤切缘阳性或不明确的患者被排除。在其余222例研究患者中，分别有42例（18.9%）和97例（43.7%）患者存在并存的限制性或阻塞性通气功能障碍。在中位随访期30.6个月时，5年总生存率和无复发生存率分别为69.0%和62.6%。多因素分析显示，高分辨率计算机断层扫描（HRCT）显示的ILD、提示限制性通气功能障碍的肺功能测试结果以及楔形切除术是总生存期较差的独立危险因素。血清鳞状细胞癌抗原（SCC-Ag）水平升高（>1.5 ng/mL）以及与总生存期较差相同的危险因素是复发的独立危险因素。在接受解剖性肺切除术（肺叶切除术和肺段切除术，n = 173）的患者中，限制性通气功能障碍是总生存期较差的独立危险因素，多因素分析显示血清SCC-Ag水平升高、HRCT显示的ILD以及限制性通气功能障碍是无复发生存期较差的独立危险因素。脏层胸膜侵犯、淋巴管或血管侵犯等因素与预后无显著相关性。
限制性通气功能障碍对cT1aN0M0周围型SqCC肺癌患者的预后有负面影响。
