Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Department of Pathology, Peking University People's Hospital, Beijing, China.
Thorac Cancer. 2021 Aug;12(15):2205-2213. doi: 10.1111/1759-7714.14049. Epub 2021 Jun 28.
To accurately describe the pattern, timing and predictors of disease recurrence after curative resection for different types of early-stage lung adenocarcinoma (LUAD).
A total of 1962 patients with early-stage LUAD were included. The presence of micropapillary, solid components or poorly differentiated cancer as a clinical variable was named "high-grade" adenocarcinoma (HGADC), while others were classified as "low-grade" adenocarcinoma (LGADC). Predictive factors for specific recurrence patterns were assessed by univariate and multivariate analyses using Cox-proportional hazard regression models. Event dynamics, based on the hazard rate, were evaluated.
At a median follow-up of 36.0 months, 137 (6.98%) of 1962 patients suffered from recurrence. Multivariable Cox analysis revealed that HGADC was an independent predictor for overall recurrence (hazard ratio [HR] 3.08, 95% confidence interval [CI] 2.09-4.52, p < 0.001), local recurrence (HR 2.77, 95% CI 1.38-5.55, p < 0.001), distant metastasis (HR 3.22, 95% CI 2.03-5.11, p < 0.001), chest recurrence (HR 2.80, 95% CI 1.65-4.75, p < 0.001) and brain recurrence (HR 4.11, 95% CI 1.83-9.22, p < 0.001). However, HGADC (HR 1.56, 95% CI 0.63-3.86, p = 0.335 in univariate analysis) was not a risk factor for bone recurrence. The hazard curve of the whole group presented a double-peaked pattern. Different types of LUAD had different hazard curves. HGADC patients exhibited higher hazard rates than LGADC patients during the whole follow-up. In addition, the recurrence hazard curve in HGADC patients showed a typical "double-peaked" pattern, while the curve in LGADC patients displayed a smooth curve after surgery.
Different postoperative recurrence patterns were seen in HGADC and LGADC. Site-specific recurrence patterns were also different in HGADC and LGADC types.
准确描述不同类型早期肺腺癌（LUAD）根治性切除术后疾病复发的模式、时间和预测因素。
共纳入 1962 例早期 LUAD 患者。将微乳头、实体成分或低分化癌作为临床变量命名为“高级别”腺癌（HGADC），其他则分类为“低级别”腺癌（LGADC）。使用 Cox 比例风险回归模型的单变量和多变量分析评估特定复发模式的预测因素。基于风险率评估事件动态。
中位随访 36.0 个月时，1962 例患者中有 137 例（6.98%）发生复发。多变量 Cox 分析显示，HGADC 是总复发（风险比 [HR] 3.08，95%置信区间 [CI] 2.09-4.52，p<0.001）、局部复发（HR 2.77，95% CI 1.38-5.55，p<0.001）、远处转移（HR 3.22，95% CI 2.03-5.11，p<0.001）、胸部复发（HR 2.80，95% CI 1.65-4.75，p<0.001）和脑转移（HR 4.11，95% CI 1.83-9.22，p<0.001）的独立预测因素。然而，HGADC（单变量分析中 HR 1.56，95% CI 0.63-3.86，p=0.335）不是骨转移的危险因素。全组的危险曲线呈双峰模式。不同类型的 LUAD 具有不同的危险曲线。HGADC 患者在整个随访期间的危险率高于 LGADC 患者。此外，HGADC 患者的复发危险曲线呈典型的“双峰”模式，而 LGADC 患者手术后的曲线呈平滑曲线。
HGADC 和 LGADC 患者的术后复发模式不同。HGADC 和 LGADC 类型的特定部位复发模式也不同。
