2010 年日本肺癌登记数据库中肺腺癌优势分类与肺叶切除术后病理因素的预后影响。
The prognostic impact of lung adenocarcinoma predominance classification relating to pathological factors in lobectomy, the Japanese Joint Committee of Lung Cancer Registry Database in 2010.
机构信息
Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
出版信息
BMC Cancer. 2022 Aug 10;22(1):875. doi: 10.1186/s12885-022-09973-8.
OBJECTIVE
We studied the prognosis and clinicopathological background of lung adenocarcinoma predominance among patients who underwent lobectomy using data from the Japanese Joint Committee of Lung Cancer Registry.
METHODS
Two thousand eight hundred sixty-three cases were extracted. Recurrence free survival (RFS) rates, overall survival (OS) rates and clinicopathological factors and epidermal growth factor receptor (EGFR) mutation status were examined.
RESULTS
Median follow-up period was 65.5 months. Adenocarcinoma predominance was sub-grouped according to OS and RFS rate. In pathological stage I, 5-year RFS and OS rates were respectively 92.2% and 95.8% in group A (adenocarcinoma-in-situ + minimally invasive adenocarcinoma), 89.3% and 92.1% in group B (lepidic), 79.2% and 89.7% in group C (papillary + acinar + variants) and 69.0% and 79.0% in group D (solid + micropapillary). In pathological stage II + IIIA, they were, 43.6% and 72.4% in B, 39.5% and 66.9% in C and 31.0% and 53.7% in D. Group D showed significant worst outcome both in stage I and II + IIIA. Up stage rate from clinical stage I to pathological stage II + IIIA was 0.0%, 3.7%, 15.9% and 33.3%. The frequency of lymph-vessel, vascular, pleura invasion and positive EGFR mutation were 0.0%, 0.0%, 0.0% and 57.1% in group A, 15.6%, 10.0%, 12.1% and 55.1% in B, 36.6%, 31.8%, 29.7% and 44.9% in C, 50.2%, 57.8%, 38.9% and 21.3% in D. In group D, lymph-vessel, vascular and pleura invasion were most, EGFR mutation was least frequent not only in pathological stage I but also stage II + IIIA. In multivariate analysis, age, pathological stage, vascular invasion, and group D were independent factors affected RFS and OS.
CONCLUSION
Limited to lobectomy cases, solid + micropapillary was independent prognostic factor both in early and locally advanced stage. Its malignant degree was related to the frequency of pathological invasive factors and EGFR mutation status.
目的
我们使用日本肺癌注册研究联合委员会的数据，研究了行肺叶切除术患者中肺腺癌为主型的预后和临床病理背景。
方法
从 2863 例中提取数据。检查无复发生存率（RFS）、总生存率（OS）以及临床病理因素和表皮生长因子受体（EGFR）突变状态。
结果
中位随访时间为 65.5 个月。腺癌优势根据 OS 和 RFS 率进行亚组分组。在病理 I 期，A 组（原位癌+微浸润性腺癌）的 5 年 RFS 和 OS 率分别为 92.2%和 95.8%，B 组（贴壁为主型）为 89.3%和 92.1%，C 组（乳头型+腺泡型+变异型）为 79.2%和 89.7%，D 组（实体型+微乳头型）为 69.0%和 79.0%。在病理 II+IIIA 期，B 组分别为 43.6%和 72.4%，C 组为 39.5%和 66.9%，D 组为 31.0%和 53.7%。D 组在 I 期和 II+IIIA 期均显示出明显的最差结局。从临床 I 期到病理 II+IIIA 期的升级率分别为 0.0%、3.7%、15.9%和 33.3%。A 组淋巴管、血管、胸膜侵犯和阳性 EGFR 突变的频率分别为 0.0%、0.0%、0.0%和 57.1%，B 组为 15.6%、10.0%、12.1%和 55.1%，C 组为 36.6%、31.8%、29.7%和 44.9%，D 组为 50.2%、57.8%、38.9%和 21.3%。在 D 组中，淋巴管、血管和胸膜侵犯最常见，EGFR 突变最不常见，不仅在病理 I 期，而且在 II+IIIA 期也是如此。多变量分析显示，年龄、病理分期、血管侵犯和 D 组是影响 RFS 和 OS 的独立因素。
结论
限于肺叶切除术病例，实体+微乳头型在早期和局部晚期均为独立的预后因素。其恶性程度与病理侵袭性因素和 EGFR 突变状态的频率有关。
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