Zhang H, Sun F H, Chen Z C, Wang Q
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2022 Jun 1;60(6):580-586. doi: 10.3760/cma.j.cn112139-20211008-00474.
To examine the prognostic significance of WHO classification of lung adenocarcinoma in 2021 in patients with stage Ⅰ pulmonary adenocarcinoma. The clinical data of 829 patients who underwent surgery from January 2015 to September 2016 at Department of Thoracic Surgery, Zhongshan Hospital of Fudan University and had a postoperative pathologically confirmed diagnosis of stage Ⅰ lung adenocarcinoma were analyzed retrospectively. There were 389 males and 440 females, aged (60±11) years (range: 32 to 90 years), including 570 cases with solid nodules, 259 cases with ground-glass nodule. The survival curve was plotted using the Kaplan-Meier method and compared by the Log-rank test. The Cox proportional hazards regression model was used to identify prognosis factors on overall survival (OS), and recurrence-free survival (RFS). Among the 829 patients, 470 cases were acinar predominant type, 165 cases were papillary predominant type, 90 cases were lepidic predominant type, 62 cases were solid predominant type, and 42 cases were micropapillary type. Compared with the solid nodule group, the proportion of patients with lepidic predominant type was higher in the ground glass nodule group (20.5%(53/259) 6.5%(37/570), χ²=35.922, <0.01), while the proportion of micropapillary (1.2%(3/259) 6.8%(39/570), χ²=11.961, <0.01) and solid predominant type (1.5%(4/259) 10.2%(58/570), χ²=19.172, <0.01) was lower. Survival analysis of 829 patients showed that patients with the lepidic predominant had the best prognosis, those with acinar and papillary predominant were worse, and patients with solid and micropapillary predominant had the worst prognosis (all <0.01). The independent prognosis factors associated with postoperative recurrence were T2 stage (=1.631, 95%: 1.030 to 2.583, =0.037), pathologic subtype (=0.036), presence of a micropapillary component (=1.764, 95%: 1.143 to 2.722, =0.010), and solid nodule in CT picture (=18.690, 95%: 7.587 to 46.043, <0.01). Subgroup analysis showed that in both solid and ground-glass nodules, the presence of a solid-type component was a prognosis factor for overall survival, and the presence of a micropapillary component was a prognosis factor for recurrence-free survival. The presence of micropapillary and solid component, in addition to histological subtype, are prognosis factors for patients with stage Ⅰ lung adenocarcinoma. For patients with stage Ⅰ lung adenocarcinoma, the combination of pathological subtype and T-stage is more valuable and reliable for prognosis.
探讨2021年世界卫生组织（WHO）肺腺癌分类对Ⅰ期肺腺癌患者的预后意义。回顾性分析2015年1月至2016年9月在复旦大学附属中山医院胸外科接受手术且术后病理确诊为Ⅰ期肺腺癌的829例患者的临床资料。其中男性389例，女性440例，年龄（60±11）岁（范围：32至90岁），包括实性结节570例，磨玻璃结节259例。采用Kaplan-Meier法绘制生存曲线并通过Log-rank检验进行比较。采用Cox比例风险回归模型确定总生存（OS）和无复发生存（RFS）的预后因素。829例患者中，腺泡为主型470例，乳头为主型165例，鳞屑为主型90例，实体为主型62例，微乳头型42例。与实性结节组相比，磨玻璃结节组中鳞屑为主型患者比例更高（20.5%（53/259）对6.5%（37/570），χ²=35.922，P<0.01），而微乳头型（1.2%（3/259）对6.8%（39/570），χ²=11.961，P<0.01）和实体为主型（1.5%（4/259）对10.2%（58/570），χ²=19.172，P<）比例更低。829例患者的生存分析显示，鳞屑为主型患者预后最佳，腺泡和乳头为主型较差，实体和微乳头为主型患者预后最差（均P<0.01）。与术后复发相关的独立预后因素为T2期（HR=1.631，95%CI：1.030至2.583，P=0.037）、病理亚型（P=0.036）、微乳头成分的存在（HR=1.764，95%CI：1.143至2.722，P=0.010）以及CT图像中的实性结节（HR=18.690，95%CI：7.587至46.043，P<0.01）。亚组分析显示，在实性和磨玻璃结节中，实性成分的存在是总生存的预后因素，微乳头成分的存在是无复发生存的预后因素。微乳头和实性成分的存在，除组织学亚型外，是Ⅰ期肺腺癌患者的预后因素。对于Ⅰ期肺腺癌患者，病理亚型和T分期的联合对预后更有价值且可靠。
