Ma Minjie, She Yunlang, Ren Yijiu, Dai Chenyang, Zhang Lei, Xie Huikang, Wu Chunyan, Yang Minglei, Xie Dong, Chen Chang
Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China.
J Thorac Dis. 2018 Sep;10(9):5384-5393. doi: 10.21037/jtd.2018.08.64.
Our study aimed to evaluate the prognostic significance and adjuvant chemotherapy (ACT) benefits of a micropapillary/solid (MS) pattern in patients with stage IB lung adenocarcinoma.
Patients with pathologically-confirmed stage IB adenocarcinoma who underwent surgical resection between January 2009 and December 2011 were included. The tumors were reclassified into three categories: MS patterns absent (MS-); non-predominant MS patterns (MS+); predominant MS (MS++). The correlations of prognosis and ACT with recurrence-free survival (RFS) were evaluated.
Overall, 497 (MS-, n=269; MS+, n=177; MS++, n=51) patients were enrolled in the study. In univariate analysis, the MS+ [hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.030-2.006; P=0.033] and MS++ (HR, 2.818; 95% CI, 1.792-4.432; P<0.001) groups had significantly poor prognosis compared with MS- group. Multivariate analysis revealed that age ≥65 (HR, 1.504; 95% CI, 1.077-2.099; P=0.017), serum level of carcinoembryonic antigen (CEA) ≥10 ng/mL (HR, 1.658; 95% CI, 1.048-2.623; P=0.031) and MS++ (HR, 2.529; 95% CI, 1.550-4.126; P<0.001) were significant prognostic factors. Furthermore, subgroup analysis showed that MS++ patients but not MS- and MS+ derived RFS (recurrence-free survival) benefit from ACT (HR, 0.357; 95% CI, 0.152-0.836; P=0.018).
MS pattern successfully differentiated the prognosis difference among stage IB lung adenocarcinomas and identified patients who benefitted from ACT.
我们的研究旨在评估微乳头/实性（MS）模式对IB期肺腺癌患者的预后意义及辅助化疗（ACT）的获益情况。
纳入2009年1月至2011年12月间接受手术切除且病理确诊为IB期腺癌的患者。肿瘤被重新分类为三类：无MS模式（MS-）；非主导性MS模式（MS+）；主导性MS（MS++）。评估预后及ACT与无复发生存期（RFS）的相关性。
总体上，497例患者（MS-，n = 269；MS+，n = 177；MS++，n = 51）纳入研究。单因素分析中，与MS-组相比，MS+组[风险比（HR），1.437；95%置信区间（CI），1.030 - 2.006；P = 0.033]和MS++组（HR，2.818；95% CI，1.792 - 4.432；P < 0.001）预后显著较差。多因素分析显示，年龄≥65岁（HR，1.504；95% CI，1.077 - 2.099；P = 0.017）、癌胚抗原（CEA）血清水平≥10 ng/mL（HR，1.658；95% CI，1.048 - 2.623；P = 0.031）和MS++（HR，2.529；95% CI，1.550 - 4.126；P < 0.001）是显著的预后因素。此外，亚组分析显示，MS++患者而非MS-和MS+患者从ACT中获得无复发生存期（RFS）获益（HR，0.357；95% CI，0.152 - 0.836；P = 0.018）。
MS模式成功区分了IB期肺腺癌患者的预后差异，并确定了能从ACT中获益的患者。
