Yu Dongzhi, Sun Yanbin, McNutt Michael A, Xu Shun
Department of General Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Pathology and Molecular Biology, School of Medicine and Research Institute, Peking University, Beijing, China.
Front Surg. 2022 Apr 25;9:853363. doi: 10.3389/fsurg.2022.853363. eCollection 2022.
The prognosis for stage I pulmonary adenocarcinoma is generally good. However, some patients with stage I pulmonary adenocarcinoma have an unexpectedly poor outcome. This warrants consideration of adjunct markers. In this study, we analyze carcinoembryonic antigen, Ki-67, and a pathologic subtype in combination for prognostic evaluation of stage I pulmonary adenocarcinoma. These factors were selected for study as they have been shown to be individually associated with prognosis in many studies.
A total of 650 patients with stage I pulmonary adenocarcinoma were investigated retrospectively. Each patient was re-staged using standard TNM criteria. Carcinoembryonic antigen (CEA) values were obtained from preoperative blood samples, and Ki-67 was evaluated with tumor tissue immunohistochemistry. Patient clinicopathologic characteristics, survival status, and date of death were obtained from medical records and telephone follow-up.
CEA > 4.4 ng/ml, Ki-67 > 13%, and a solid-micropapillary tumor growth pattern were each independent adverse prognostic markers for 5-year disease specific survival in stage I pulmonary adenocarcinoma. However, in combination, these 3 factors yielded a prognostic value (designated "CEA-Ki-67-pathologic subtype" value). Stage I pulmonary adenocarcinoma of low-risk CEA-Ki-67-pathologic subtype (CKP) value show biologic behavior similar to TNM stage IA1 tumors, while stage I tumors of high-risk CKP value are similar in prognosis to TNM stage II.
The CKP value may be used as an adjunct to the TNM classification, which may yield a more accurately defined prognosis for cases of stage I pulmonary adenocarcinoma. CKP value may identify patients at higher risk who may benefit from adjuvant chemotherapy. Conversely, lower risk CKP values may support avoidance of chemotherapy.
I期肺腺癌的预后通常较好。然而，一些I期肺腺癌患者的预后出乎意料地差。这就需要考虑辅助标志物。在本研究中，我们联合分析癌胚抗原、Ki-67和病理亚型，以评估I期肺腺癌的预后。选择这些因素进行研究是因为在许多研究中已表明它们各自与预后相关。
对650例I期肺腺癌患者进行回顾性研究。每位患者均使用标准TNM标准重新分期。从术前血样中获取癌胚抗原（CEA）值，并通过肿瘤组织免疫组化评估Ki-67。从病历和电话随访中获取患者的临床病理特征、生存状态和死亡日期。
CEA>4.4 ng/ml、Ki-67>13%以及实性微乳头肿瘤生长模式均是I期肺腺癌5年疾病特异性生存的独立不良预后标志物。然而，这3个因素联合产生了一个预后值（称为“CEA-Ki-67-病理亚型”值）。低风险CEA-Ki-67-病理亚型（CKP）值的I期肺腺癌显示出与TNM IA1期肿瘤相似的生物学行为，而高风险CKP值的I期肿瘤预后与TNM II期相似。
CKP值可作为TNM分类的辅助指标，这可能为I期肺腺癌病例提供更准确的预后定义。CKP值可识别可能从辅助化疗中获益的高风险患者。相反，低风险CKP值可能支持避免化疗。
