Yang Zijiang, Li Xiongfei, Bai Jinsong, Li Di, Ma Zelin, Deng Chaoqiang, Fu Fangqiu, Zhang Yang
Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
Institute of Thoracic Oncology, Fudan University, Shanghai, China.
Ann Surg Oncol. 2023 Nov;30(12):7481-7491. doi: 10.1245/s10434-023-14016-y. Epub 2023 Aug 3.
This study aimed to determine the prognostic factors for the long-term outcome of stage IB non-small cell lung cancer (NSCLC).
Surgically resected patients with stage IB NSCLC diagnosed (based on TNM 8th edition) between April 2008 and December 2013 were retrospectively reviewed. The prognosis and possible risk factors among the stage IB NSCLC patients were evaluated.
Of the 349 patients identified for the study, 80 (22.9%) received post-surgery adjuvant chemotherapy (ACT). The median follow-up time after surgery was 123.3 months. The 10-year overall survival (OS) rate was 69.6%, and the 10-year recurrence-free survival (RFS) rate was 62.8%. The patients in this cohort were divided into three groups (T1 with visceral pleural invasion [VPI], T2a without VPI, and T2a with VPI), and no significant differences in OS or RFS were found among the groups. Furthermore, survival analysis indicated that the absence of ground-glass opacity (GGO) components portends an adverse long-term OS and RFS. In a subgroup of patients with solid nodules, age older than 65 years (hazard ratio [HR] 1.987; 95% confidence interval [CI] 1.312-3.010; p = 0.001) and ACT (HR 0.392; 95% CI 0.225-0.684; p < 0.001) were independent prognostic factors for OS, whereas lymphovascular invasion (HR 1.792; 95% CI 0.995-3.227; p = 0.052) should be considered as an independent unfavorable prognostic factor for RFS.
As an upstaging factor, VPI did not further stratify prognosis for the stage IB patients in our cohort. The presence of GGO components had a notable impact on a favorable prognosis in stage IB NSCLCs.
本研究旨在确定ⅠB期非小细胞肺癌（NSCLC）长期预后的预测因素。
回顾性分析2008年4月至2013年12月间手术切除的ⅠB期NSCLC患者（基于TNM第8版诊断）。评估ⅠB期NSCLC患者的预后及可能的危险因素。
本研究纳入的349例患者中，80例（22.9%）接受了术后辅助化疗（ACT）。术后中位随访时间为123.3个月。10年总生存率（OS）为69.6%，10年无复发生存率（RFS）为62.8%。该队列患者分为三组（有脏层胸膜侵犯[VPI]的T1组、无VPI的T2a组和有VPI的T2a组），三组间OS或RFS无显著差异。此外，生存分析表明，无磨玻璃影（GGO）成分预示着不良的长期OS和RFS。在实性结节患者亚组中，年龄大于65岁（风险比[HR] 1.987；95%置信区间[CI] 1.312 - 3.010；p = 0.001）和ACT（HR 0.392；95% CI 0.225 - 0.684；p < 0.001）是OS的独立预测因素，而脉管侵犯（HR 1.792；95% CI 0.995 - 3.227；p = 0.052）应被视为RFS的独立不良预测因素。
作为一个分期上调因素，VPI并未进一步对本队列中ⅠB期患者的预后进行分层。GGO成分的存在对ⅠB期NSCLC的良好预后有显著影响。
