Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
Ann Surg Oncol. 2024 Dec;31(13):9310-9320. doi: 10.1245/s10434-024-16045-7. Epub 2024 Aug 19.
Although visceral pleural invasion, lymphovascular invasion, tumor spread through air spaces, and poor differentiation are pathological risk factors associated with unfavorable prognosis in patients with lung adenocarcinoma, the cumulative impact of these factors on prognosis remains unclear.
We enrolled 1532 patients with stage I lung adenocarcinoma. Patients were divided according to the number of risk factors as follows: Group A (without risk factors), Group B (one risk factor), and Group C (multiple risk factors). Moreover, we stratified patients into two subgroups based on tumor size (≤ 3 cm, 3-4 cm). Kaplan-Meier analysis was used to evaluate 5-year disease-free survival (DFS) and overall survival (OS).
Overall, 949, 404, and 179 patients were included in Groups A, B, and C, respectively. Group C had a larger tumor size and more cases of extrathoracic recurrence than the other groups. The 5-year DFS and OS gradually decreased across Groups A to C (DFS: 94.3%, 80.6%, and 64.3%, respectively, p < 0.001; OS: 97.2%, 92.7%, and 77%, respectively, p < 0.001). A similar trend was observed for tumors ≤ 3 cm in size (DFS: 95.2%, 83.2%, and 68.5%, respectively, p < 0.001; OS: 97.6%, 94.1%, and 79.6%, respectively, p < 0.001), but a less pronounced trend was observed for tumors between 3 and 4 cm in size (DFS: 72.1, 60.8, and 43.3%, respectively, p = 0.054; OS: 85.7, 82.1, and 64.7%, respectively, p = 0.16).
Postoperative survival worsened with increasing pathological risk factors in patients with stage I lung adenocarcinoma, especially those with tumor size ≤ 3 cm.
虽然内脏胸膜侵犯、脉管侵犯、肿瘤气腔播散和低分化是与肺腺癌患者预后不良相关的病理危险因素，但这些因素对预后的累积影响尚不清楚。
我们纳入了 1532 例Ⅰ期肺腺癌患者。根据危险因素的数量将患者分为以下三组：A 组（无危险因素）、B 组（一个危险因素）和 C 组（多个危险因素）。此外，我们还根据肿瘤大小将患者分为两组（≤3cm、3-4cm）。采用 Kaplan-Meier 分析评估 5 年无病生存率（DFS）和总生存率（OS）。
总体而言，A、B 和 C 组分别纳入 949、404 和 179 例患者。C 组的肿瘤较大，且有更多的胸外复发病例。随着 A 组至 C 组，5 年 DFS 和 OS 逐渐降低（DFS：94.3%、80.6%和 64.3%，p<0.001；OS：97.2%、92.7%和 77%，p<0.001）。肿瘤大小≤3cm 时也观察到类似的趋势（DFS：95.2%、83.2%和 68.5%，p<0.001；OS：97.6%、94.1%和 79.6%，p<0.001），但肿瘤大小在 3-4cm 之间时的趋势则不那么明显（DFS：72.1%、60.8%和 43.3%，p=0.054；OS：85.7%、82.1%和 64.7%，p=0.16）。
在Ⅰ期肺腺癌患者中，随着病理危险因素的增加，术后生存状况恶化，尤其是肿瘤大小≤3cm 的患者。
