Ouyang Y Q, Ni L F, Liu X M
Department of Geriatrics, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Feb 18;52(1):158-162. doi: 10.19723/j.issn.1671-167X.2020.01.025.
To explore the prognosis factors that influence the postoperative survival rate in patients with malignant solitary pulmonary nodules and to provide a reference for the prognosis risk stratification of early lung cancer patients.
In this study, we retrospectively reviewed 172 patients who were admitted to Peking University First Hospital from April 2006 to December 2013. All cases were radiologically defined as solitary pulmonary nodule and were pathologically confirmed to be stage Ia non-small cell lung cancer after surgical procedure. The patients' clinical and follow-up data were summarized and analyzed. The relevance between survival time and factors that may affect patients' prognosis was evaluated, which included gender, age, clinical symptoms, smoking history, comorbidity index, tumor biomarkers, nodule type, type of surgery, nodule location, nodule histopathological type, nodule size, histopathological differentiation grade, proliferating cell nuclear antigen Ki-67 expression level and epidermal growth factor receptor (EGFR) gene mutation. Kaplan-Meier survival analysis, Cox univariant and multivariant regression analysis were conducted to evaluate the factors affecting prognosis.
The 3-year overall survival rate of the atients with malignant solitary pulmonary nodules was 93.6%, and the 5-year overall survival rate was 89.8%. KaplanMeier survival analysis and Cox univariant regression analysis showed that the overall survival rate of the male patients was significantly lower than that of the female patients. In addition, the elderly patients with histopathology characterized as high Ki-67 proliferation index were also associated with the worse overall survival (P<0.05). Cox multivariant regression analysis demonstrated that age more than 65 years as well as the high Ki-67 expression level were independent risk factors for overall survival in patients with malignant solitary pulmonary nodules (age: P=0.023, HR=3.531, 95%CI 1.190-10.472; Ki-67: P=0.004, HR=1.021, 95%CI 1.007-1.035).
For patients with malignant solitary pulmonary nodules, with pathological defined as stage Ia non-small cell lung cancer, age, gender and Ki-67 expression levels might be important prognostic factors. Comprehensive consideration of Ki-67 proliferation index and clinical pathological features may help to stratify the prognosis more accurately and guide the selection of appropriate therapeutic strategies, which needs to be verified by multi-center studies.
探讨影响恶性孤立性肺结节患者术后生存率的预后因素，为早期肺癌患者的预后风险分层提供参考。
本研究回顾性分析了2006年4月至2013年12月在北京大学第一医院住院的172例患者。所有病例经影像学诊断为孤立性肺结节，术后病理确诊为Ia期非小细胞肺癌。总结并分析患者的临床及随访资料。评估生存时间与可能影响患者预后的因素之间的相关性，这些因素包括性别、年龄、临床症状、吸烟史、合并症指数、肿瘤标志物、结节类型、手术方式、结节位置、结节组织病理学类型、结节大小、组织病理学分化程度、增殖细胞核抗原Ki-67表达水平及表皮生长因子受体（EGFR）基因突变。采用Kaplan-Meier生存分析、Cox单因素及多因素回归分析评估影响预后的因素。
恶性孤立性肺结节患者的3年总生存率为93.6%，5年总生存率为89.8%。Kaplan-Meier生存分析和Cox单因素回归分析显示，男性患者的总生存率显著低于女性患者。此外，组织病理学表现为Ki-67增殖指数高的老年患者的总生存率也较差（P<0.05）。Cox多因素回归分析表明，年龄大于65岁以及Ki-67表达水平高是恶性孤立性肺结节患者总生存的独立危险因素（年龄：P=0.023，HR=3.531，95%CI 1.190-10.472；Ki-67：P=0.004，HR=1.021，95%CI 1.007-1.035）。
对于病理诊断为Ia期非小细胞肺癌的恶性孤立性肺结节患者，年龄、性别及Ki-67表达水平可能是重要的预后因素。综合考虑Ki-67增殖指数及临床病理特征可能有助于更准确地进行预后分层并指导选择合适的治疗策略，这有待多中心研究验证。
