Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Eur J Cardiothorac Surg. 2021 Apr 13;59(3):617-623. doi: 10.1093/ejcts/ezaa353.
The aim of this study was to assess the relationship between visceral pleural invasion (VPI), lymphovascular invasion (LVI) and other clinicopathological characteristics and their prognostic impact on surgically resected adenosquamous carcinoma (ASC).
We retrospectively reviewed 256 patients with radically resected ASC between January 2010 and December 2015. Patients were divided into 2 groups: those with VPI and those with LVI. The effects of VPI and LVI on disease-free survival and overall survival were evaluated, further stratified by tumour size and lymph node status.
Finally, 213 patients with ASC were enrolled in our study. VPI was correlated with tumour location (P < 0.001), pT stage (P < 0.001) and pN stage (P = 0.012). LVI was related to age (P = 0.005) and pN stage (P = 0.003). Both VPI and LVI were adverse prognostic factors for disease-free survival (P = 0.008, P = 0.028) and overall survival (P = 0.005, P = 0.009) using the Kaplan-Meier method. In multivariable analysis only, VPI was an independent risk factor for disease-free survival [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.42-0.87; false discovery rate, adjusted P = 0.020] and overall survival (HR 0.60, 95% CI 0.42-0.86; false discovery rate, adjusted P = 0.017). When the prognostic value of VPI was stratified by tumour size and lymph node status, we observed that only patients with VPI in tumours ≤4 cm and patients with N0 status had a worse prognosis than those without visceral invasion (P < 0.05).
VPI and LVI were poor prognostic factors in patients with ASC, but only VPI was an independent factor for survival, especially in patients with tumours ≤4 cm and pN0 status.
本研究旨在评估内脏胸膜侵犯（VPI）、脉管侵犯（LVI）与其他临床病理特征之间的关系及其对手术切除的肺腺鳞癌（ASC）患者的预后影响。
我们回顾性分析了 2010 年 1 月至 2015 年 12 月期间行根治性切除术的 256 例 ASC 患者。将患者分为 2 组：VPI 组和 LVI 组。评估 VPI 和 LVI 对无病生存率和总生存率的影响，并进一步按肿瘤大小和淋巴结状态进行分层。
最终，本研究纳入 213 例 ASC 患者。VPI 与肿瘤位置（P<0.001）、pT 分期（P<0.001）和 pN 分期（P=0.012）相关。LVI 与年龄（P=0.005）和 pN 分期（P=0.003）相关。VPI 和 LVI 均是无病生存率（P=0.008，P=0.028）和总生存率（P=0.005，P=0.009）的不良预后因素，采用 Kaplan-Meier 法。多变量分析仅显示，VPI 是无病生存率（危险比[HR]0.61，95%置信区间[CI]0.42-0.87；错误发现率校正 P=0.020）和总生存率（HR 0.60，95%CI 0.42-0.86；错误发现率校正 P=0.017）的独立危险因素。当根据肿瘤大小和淋巴结状态对 VPI 的预后价值进行分层时，我们观察到仅在肿瘤直径≤4cm 且 N0 状态的患者中，VPI 患者的预后比无内脏侵犯的患者差（P<0.05）。
VPI 和 LVI 是 ASC 患者的不良预后因素，但只有 VPI 是生存的独立因素，尤其是在肿瘤直径≤4cm 且 pN0 状态的患者中。
