Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Hum Pathol. 2021 Feb;108:84-92. doi: 10.1016/j.humpath.2020.11.007. Epub 2020 Nov 25.
The objective of this study was to analyze the clinical and pathological characteristics of patients with small cell lung cancer (SCLC) after curative surgery and to explore prognostic factors for disease-free survival (DFS) and overall survival (OS). Clinical data of 247 patients were collected, and clinicopathological features were retrieved, including gender, age, smoking history, tumor location, and distant metastasis. Histopathological features were also reviewed by three pathologists, including primary tumor (T), lymph node metastasis (N), pleural invasion, bronchial invasion, nerve invasion, spread through air spaces (STAS), tumor thrombosis, major cell shape (round Vs. spindle), tumor necrosis, stromal fibrosis, and tumor-infiltrating lymphocytes (TILs). Immunohistochemical staining of neuroendocrine markers (CD56, synapsin, chromogranin A) was also reviewed. All patients were followed up for recurrence, distant metastasis, and survival. Kaplan-Meier curves and log-rank tests were applied for survival analysis. The median DFS was 98 months, and the 1-year, 3-year, and 5-year DFS rates were 70.9%, 54.4%, and 52.2%, respectively. The median OS was not reached, and the 1-year, 3-year, and 5-year survival rates were 94.2%, 72.3%, and 65.4%, respectively. Univariate analysis revealed clinicopathological features with DFS (gender, smoking history, primary tumor, regional lymph node metastasis, major cell shape, and TILs) and OS (age, primary tumor, regional lymph node metastasis, distant metastasis, nerve invasion, major cell shape, and TILs). Multivariate analysis revealed DFS-related factors (smoking history, regional lymph node metastasis and major cell shape) and OS-related factors (age, primary tumor, distant metastasis in the brain, liver, bone, nerve invasion, and TILs). Age more than 65 years, smoking, advanced stage (T and N), distant metastasis, nerve invasion, major cell shape as spindle and TILs >30% were negatively correlated with survival. Neuroendocrine immunostaining markers showed no correlation with survival. Of interest, spindle cell type and TILs >30% are revealed as independent negative prognostic factors, and further molecular mechanisms need to be explored.
本研究旨在分析小细胞肺癌（SCLC）患者根治术后的临床病理特征，并探讨无病生存（DFS）和总生存（OS）的预后因素。收集了 247 例患者的临床资料，回顾了包括性别、年龄、吸烟史、肿瘤部位和远处转移在内的临床病理特征。还由 3 位病理学家回顾了组织病理学特征，包括原发肿瘤（T）、淋巴结转移（N）、胸膜侵犯、支气管侵犯、神经侵犯、空气空间扩散（STAS）、肿瘤血栓形成、主要细胞形状（圆形与梭形）、肿瘤坏死、间质纤维化和肿瘤浸润淋巴细胞（TILs）。还回顾了神经内分泌标志物（CD56、突触素、嗜铬粒蛋白 A）的免疫组织化学染色。所有患者均接受随访以评估复发、远处转移和生存情况。应用 Kaplan-Meier 曲线和对数秩检验进行生存分析。中位 DFS 为 98 个月，1 年、3 年和 5 年 DFS 率分别为 70.9%、54.4%和 52.2%。中位 OS 未达到，1 年、3 年和 5 年生存率分别为 94.2%、72.3%和 65.4%。单因素分析显示，DFS 相关的临床病理特征（性别、吸烟史、原发肿瘤、区域淋巴结转移、主要细胞形状和 TILs）和 OS 相关的临床病理特征（年龄、原发肿瘤、区域淋巴结转移、远处转移、神经侵犯、主要细胞形状和 TILs）。多因素分析显示，DFS 相关因素（吸烟史、区域淋巴结转移和主要细胞形状）和 OS 相关因素（年龄、原发肿瘤、脑、肝、骨转移、神经侵犯和 TILs）。年龄大于 65 岁、吸烟、晚期（T 和 N）、远处转移、神经侵犯、梭形细胞类型和 TILs>30%与生存不良呈负相关。神经内分泌免疫染色标志物与生存无相关性。有趣的是，梭形细胞类型和 TILs>30%被揭示为独立的预后不良因素，需要进一步探索其分子机制。
