Yang Yikun, Mao Yousheng, Yang Lin, He Jie, Gao Shugeng, Mu Juwei, Xue Qi, Wang Dali, Zhao Jun, Gao Yushun, Zhang Zhirong, Ding Ningning, Yang Ding
Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
J Thorac Dis. 2017 Dec;9(12):5267-5277. doi: 10.21037/jtd.2017.11.65.
Patients with pathological stage I (p I) lung adenocarcinoma show variabilities in prognosis even after complete resection. The factors resulting in heterogeneities of prognosis remain controversy. The aim of this study was to identify the risk factors affecting recurrence/metastasis and survival in patients with curatively resected p I lung adenocarcinoma.
A total of 252 patients with p I lung adenocarcinoma underwent curative resection between January 1st, 2009 to September 30th, 2011 were retrospectively reviewed to analyze the associations of recurrence and survival with the following clinicopathological variables: gender, age, cigarette smoking, family cancer history, tumor size, TNM stage, tumor differentiation, visceral pleural invasion, bronchial involvement, lymphovascular invasion, postoperative adjuvant treatment, pathological subtypes and micropapillary pattern.
Among those 252 patients, 48 had local recurrence or distant metastasis, the rest 204 patients had no relapse until the last follow-up. Cox univariate survival analysis revealed that tumor size (P<0.001), TNM stage [disease-free survival (DFS), P<0.001; overall survival (OS), P=0.004], tumor differentiation (P<0.001), bronchial involvement (P<0.001), lymphovascular invasion (DFS, P=0.021; OS, P=0.001) and micropapillary pattern (DFS, P<0.001; OS, P=0.003) were significantly associated with DFS and OS, while cigarette smoking (P=0.029) and pathological subtypes (P=0.041) were found to be risk factors for DFS either. In multivariate analysis, tumor differentiation (P<0.001) was an independent risk factor for both DFS and OS, TNM stage (P=0.007), bronchial involvement (P=0.004) and micropapillary pattern (P=0.001) only for DFS, while tumor size (P=0.009) and lymphovascular invasion (P=0.010) were found to be independent risk factors only for OS.
Tumor size, TNM stage, tumor differentiation, bronchial involvement, lymphovascular invasion and micropapillary pattern could be considered as risk factors for predicting local recurrence or distant metastasis and survival in curatively resected p I lung adenocarcinoma patients.
病理分期为I期（p I）的肺腺癌患者即使在完全切除后预后仍存在差异。导致预后异质性的因素仍存在争议。本研究的目的是确定影响根治性切除的p I期肺腺癌患者复发/转移及生存的危险因素。
回顾性分析2009年1月1日至2011年9月30日期间共252例行根治性切除的p I期肺腺癌患者，分析复发和生存与以下临床病理变量的相关性：性别、年龄、吸烟、家族癌症史、肿瘤大小、TNM分期、肿瘤分化、脏层胸膜侵犯、支气管受累、脉管侵犯、术后辅助治疗、病理亚型和微乳头结构。
在这252例患者中，48例出现局部复发或远处转移，其余204例患者直至最后一次随访均无复发。Cox单因素生存分析显示，肿瘤大小（P<0.001）、TNM分期[无病生存期（DFS），P<0.001；总生存期（OS），P=0.004]、肿瘤分化（P<0.001）、支气管受累（P<0.001）、脉管侵犯（DFS，P=0.021；OS，P=0.001）和微乳头结构（DFS，P<0.001；OS，P=0.003）与DFS和OS显著相关，而吸烟（P=0.029）和病理亚型（P=0.041）也被发现是DFS的危险因素。多因素分析中，肿瘤分化（P<0.001）是DFS和OS的独立危险因素，TNM分期（P=0.007）、支气管受累（P=0.004）和微乳头结构（P=0.001）仅为DFS的独立危险因素，而肿瘤大小（P=0.009）和脉管侵犯（P=0.010）仅为OS的独立危险因素。
肿瘤大小、TNM分期、肿瘤分化、支气管受累、脉管侵犯和微乳头结构可被视为预测根治性切除的p I期肺腺癌患者局部复发或远处转移及生存的危险因素。
