Li Jiuzhen, Lin Xuefeng, Li Xin, Zhang Weiran, Sun Daqiang
Graduate School, Tianjin Medical University, Tianjin, China.
Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin, China.
Ann Transl Med. 2022 Feb;10(4):187. doi: 10.21037/atm-22-130.
Prognostic factors for stage IIIA lung adenocarcinoma (LUAD) are unclear. The current main treatment for stage IIIA LUAD is still controversial. Some Clinicians advocate synchronous chemoradiotherapy as the main treatment for stage IIIA LUAD. In contrast, some clinicians argue that there are still certain patients with stage IIIA LUAD who have a better postoperative prognosis. This study aimed to analyze preoperative factors as well as the association between somatic mutations and prognosis in stage IIIA LUAD [including overall survival (OS) time and the risk of postoperative recurrence].
This study retrospectively reviewed the data of patients with stage IIIA LUAD who underwent radical resection of lung cancer in the thoracic surgery department of Tianjin Chest Hospital from January 01, 2011 to September 30, 2016. All patients involved in the study provided written informed consent. The associations between OS and DFS and the clinical characteristics as well as somatic mutations of patients were analyzed separately. The Kaplan-Meier method was used for univariate analysis, and survival curves were drawn. Multivariate analysis was performed by the Cox regression model.
For univariate analysis, the prognostic factors of OS were the level of preoperative CYFRA21-1, the number of metastatic lymph node stations (NMLS), maximum tumor diameter, EGFR (epidermal growth factor receptor) classical base mutations, and the number of copies of POLE (polymerase epsilon) mutation (NCPM). Preoperative total protein level, preoperative CYFRA21-1 level, the number of metastatic lymph nodes (NMLN), maximum tumor diameter, the number of mutated genes (NMG) in tumor samples, TP53 mutations, and the number of copies of POLE mutation (NCPM) were associated with disease-free survival (DFS). The multivariate analysis showed that the preoperative CYFRA21-1 level, the number of metastatic lymph node stations (NMLS), and EGFR typical base mutations were independent prognostic factors of OS. The number of mutated genes (NMG), EGFR classical base mutations, preoperative NSE level, maximum tumor diameter, and the number of metastatic lymph node stations (NMLS) were independent prognostic factors for DFS.
The preoperative level of tumor markers, the number of metastatic lymph node stations, and EGFR typical base mutations are important factors for the prognosis of patients with resectable stage IIIA LUAD.
ⅢA期肺腺癌（LUAD）的预后因素尚不清楚。目前ⅢA期LUAD的主要治疗方法仍存在争议。一些临床医生主张同步放化疗作为ⅢA期LUAD的主要治疗方法。相比之下，一些临床医生认为仍有部分ⅢA期LUAD患者术后预后较好。本研究旨在分析ⅢA期LUAD的术前因素以及体细胞突变与预后之间的关联[包括总生存期（OS）和术后复发风险]。
本研究回顾性分析了2011年1月1日至2016年9月30日在天津市胸科医院胸外科接受肺癌根治性切除术的ⅢA期LUAD患者的数据。所有参与研究的患者均提供了书面知情同意书。分别分析了患者的OS、无病生存期（DFS）与临床特征以及体细胞突变之间的关联。采用Kaplan-Meier法进行单因素分析，并绘制生存曲线。采用Cox回归模型进行多因素分析。
单因素分析显示，OS的预后因素为术前CYFRA21-1水平、转移淋巴结站数（NMLS）、最大肿瘤直径、表皮生长因子受体（EGFR）经典碱基突变以及POLE（聚合酶ε）突变拷贝数（NCPM）。术前总蛋白水平、术前CYFRA21-1水平、转移淋巴结数（NMLN）、最大肿瘤直径、肿瘤样本中突变基因数（NMG）、TP53突变以及POLE突变拷贝数（NCPM）与无病生存期（DFS）相关。多因素分析显示，术前CYFRA21-1水平、转移淋巴结站数（NMLS）和EGFR典型碱基突变是OS的独立预后因素。突变基因数（NMG）、EGFR经典碱基突变、术前神经元特异性烯醇化酶（NSE）水平、最大肿瘤直径和转移淋巴结站数（NMLS）是DFS的独立预后因素。
术前肿瘤标志物水平、转移淋巴结站数和EGFR典型碱基突变是可切除ⅢA期LUAD患者预后的重要因素。
