第八版 TNM 分类中病理分期 IA 期肺腺癌中血管和淋巴管侵犯的预后意义。
Prognostic significance of blood and lymphatic vessel invasion in pathological stage IA lung adenocarcinoma in the 8th edition of the TNM classification.
机构信息
Kanagawa Cancer Center, Department of Thoracic Surgery, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan.
Kanagawa Cancer Center, Department of Pathology, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa, 241-8515, Japan.
出版信息
Lung Cancer. 2019 Nov;137:144-148. doi: 10.1016/j.lungcan.2019.09.022. Epub 2019 Sep 29.
OBJECTIVES
The prognostic significance of blood and lymphatic vessel invasion in the 8th edition of the Tumor, Node, Metastasis (TNM) classification remains unclear. Therefore, this study aimed to evaluate the prognostic significance of blood and lymphatic vessel invasion in p-stage IA lung adenocarcinoma in the 8th edition of the TNM classification.
MATERIALS ANDMETHODS
We retrospectively examined patients with p-Stage 0-IA lung adenocarcinoma, reclassified according to the 8th edition of the TNM classification. Blood and lymphatic vessel invasion were evaluated using hematoxylin-eosin and Elastica van Gieson and hematoxylin-eosin and anti-podoplanin antibody staining, respectively. Combined blood and lymphatic vessel invasion constituted tumor vessel invasion (TVI).
RESULTS
Overall, 306 patients were evaluated. The median follow-up period was 98.0 (range: 10-216) months. The 5-year recurrence-free survival differed significantly among patients with and without TVI in p-stage IA1 (TVI-: 100%, TVI+: 88.9%, P = 0.007) and IA2 (TVI-: 94.6%, TVI+: 80.8%, P = 0.012) but not in p-stage IA3 (TVI-: 66.7%, TVI+: 75.0%, P = 0.598). The 5-year lung cancer-specific survival also differed significantly among those with and without TVI in p-stage IA1 (TVI-: 100%, TVI+: 88.9%, P < 0.001) and IA2 (TVI-: 98.2%, TVI+: 88.7%, P = 0.043) but not in p-Stage IA3 (TVI-: 66.7%, TVI+: 75.0%, P = 0.858). No recurrence and lung cancer-specific deaths occurred in p-stage IA1 patients without TVI. On multivariate analysis, the presence of TVI was independently associated with recurrence and lung cancer-specific death in patients with p-stage IA1-2 lung adenocarcinoma. TVI did not affect the prognosis of those with p-stage IA3 adenocarcinoma.
CONCLUSION
TVI is a prognostic factor in patients with p-stage IA1-2 lung adenocarcinoma. P-stage IA1 lung adenocarcinoma without TVI may therefore be classified as minimally invasive.
目的
第 8 版肿瘤、淋巴结、转移（TNM）分类中，血液和淋巴管侵犯的预后意义仍不清楚。因此，本研究旨在评估第 8 版 TNM 分类中 p 期 IA 肺腺癌中血液和淋巴管侵犯的预后意义。
材料和方法
我们回顾性地检查了根据第 8 版 TNM 分类重新分类的 p 期 0-IA 肺腺癌患者。使用苏木精-伊红和弹性纤维 van Gieson 以及苏木精-伊红和抗 podoplanin 抗体染色分别评估血液和淋巴管侵犯。合并血液和淋巴管侵犯构成肿瘤血管侵犯（TVI）。
结果
共有 306 名患者接受了评估。中位随访时间为 98.0（范围：10-216）个月。在 p 期 IA1（TVI-：100%，TVI+：88.9%，P=0.007）和 IA2（TVI-：94.6%，TVI+：80.8%，P=0.012）中，有 TVI 的患者与无 TVI 的患者的 5 年无复发生存率差异有统计学意义，但在 p 期 IA3（TVI-：66.7%，TVI+：75.0%，P=0.598）中则无统计学意义。在 p 期 IA1（TVI-：100%，TVI+：88.9%，P<0.001）和 IA2（TVI-：98.2%，TVI+：88.7%，P=0.043）中，有 TVI 的患者与无 TVI 的患者的 5 年肺癌特异性生存率差异有统计学意义，但在 p 期 IA3（TVI-：66.7%，TVI+：75.0%，P=0.858）中则无统计学意义。无 TVI 的 p 期 IA1 患者未发生复发和肺癌特异性死亡。多变量分析显示，在 p 期 IA1-2 肺腺癌患者中，存在 TVI 与复发和肺癌特异性死亡独立相关。TVI 并不影响 p 期 IA3 腺癌患者的预后。
结论
TVI 是 p 期 IA1-2 肺腺癌患者的预后因素。因此，无 TVI 的 p 期 IA1 肺腺癌可能被归类为微创。
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