Maeda Ryo, Tomita Masaki, Usuda Katsuo, Uramoto Hidetaka
Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan.
Department of Thoracic Surgery, Kanazawa Medical University, Kanazawa, Japan.
Gen Thorac Cardiovasc Surg. 2019 Feb;67(2):239-246. doi: 10.1007/s11748-018-1007-x. Epub 2018 Sep 5.
The purpose of this study was to clarify the clinicopathologic characteristics of non-small cell lung cancer (NSCLC) patients with smoking-related chronic obstructive pulmonary disease (COPD) and to evaluate the biological behavior of this disease. We investigated the association between smoking-related COPD, the recurrence-free proportion (RFP) and the clinicopathological features of clinical stage I NSCLC patients.
Between 2005 and 2014, 218 consecutive patients with clinical stage I NSCLC underwent complete resection with lobectomy or greater and systematic lymph node dissection. Differences in categorical outcomes were evaluated by the χ test. RFPs were estimated using the Kaplan-Meier method, and differences were evaluated using the log-rank test.
The 5-year RFP of clinical stage I NSCLC patients with smoking-related COPD was 55%, which was significantly lower than in those without smoking-related COPD (85%; p < 0.001). Postoperative pathological factors, including moderate or poor histological differentiation, intratumoral vascular invasion and lymph node metastasis, were detected more often in patients with smoking-related COPD. In adenocarcinoma patients, the 5-year RFP of patients with smoking-related COPD was 47%, which was significantly lower than in those without smoking-related COPD (87%; p < 0.001). The presence of a solid component was more frequently found in patients with smoking-related COPD (p = 0.007).
Clinical stage I NSCLC patients with smoking-related COPD have histologically more invasive tumors than those without smoking-related COPD.
本研究旨在阐明患有吸烟相关慢性阻塞性肺疾病（COPD）的非小细胞肺癌（NSCLC）患者的临床病理特征，并评估该疾病的生物学行为。我们调查了吸烟相关COPD、无复发生存比例（RFP）与临床I期NSCLC患者临床病理特征之间的关联。
2005年至2014年间，218例连续的临床I期NSCLC患者接受了肺叶切除术或更大范围的完全切除及系统性淋巴结清扫。分类结果的差异通过χ检验进行评估。RFP采用Kaplan-Meier法估计，差异采用对数秩检验进行评估。
患有吸烟相关COPD的临床I期NSCLC患者的5年RFP为55%，显著低于无吸烟相关COPD的患者（85%；p<0.001）。在患有吸烟相关COPD的患者中，术后病理因素，包括中度或差的组织学分化、肿瘤内血管侵犯和淋巴结转移，更常被检测到。在腺癌患者中，患有吸烟相关COPD的患者的5年RFP为47%，显著低于无吸烟相关COPD的患者（87%；p<0.001）。在患有吸烟相关COPD的患者中，实性成分的出现更为频繁（p=0.007）。
患有吸烟相关COPD的临床I期NSCLC患者在组织学上比无吸烟相关COPD的患者具有更具侵袭性的肿瘤。
