Taipei Veterans General Hospital, Division of Thoracic Surgery, Department of Surgery Taipei, Taiwan.
Department of Pathology Taipei, Taiwan.
Eur J Surg Oncol. 2024 Oct;50(10):108540. doi: 10.1016/j.ejso.2024.108540. Epub 2024 Jul 10.
This study evaluates the prognostic impact of the new grading system for lung adenocarcinoma, stratified by lymphadenectomy extent.
We analyzed 1258 lung adenocarcinoma patients who underwent curative resections between 2006 and 2017. We analyzed overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) across tumor grades and lymphadenectomy extent, categorized as IASLC-R0 (complete resection) or R(un) (uncertain resection).
The median age of cohort was 63 and 41.9 % were male. The majority had undergone lobectomy. The distribution of tumors was 274 grade 1, 558 grade 2, and 426 grade 3 cases. After a median follow-up time of 102 months, the 10-year OS/CSS/RFS rates worsened significantly across grade 1-3: 92.4/99.3/92.3 %, 77.8/87.5/71.7 %, and 63.6/70.2/52.0 %, respectively (p < 0.001). Multivariate Cox regression analysis identified grade 3, R(un) lymphadenectomy, higher Charlson Comorbidity Index, smoking history, thoracotomy, higher pathology stage, and angiolymphatic invasion as independent prognostic factors for lower OS, CSS, and RFS. Furthermore, grade 3 patients benefited significantly from IASLC-R0 lymphadenectomy, showing significantly better OS and RFS than those who underwent R(un) lymphadenectomy (p = 0.007 for OS, p = 0.001 for RFS, post-propensity score matching). Among grade 3 tumors underwent R0 or R(un) resections found the incidence rates of local, distant, and simultaneous local and distant recurrence were 8.5 % vs 13.7 %, 11.0 % vs 12.2 %, and 11.0 % vs 20.6 %, respectively.
Surgical outcomes for lung adenocarcinoma have declined across grades 1-3. IASLC-R(un) treatment worsens OS and RFS in grade 3. Intensive monitoring and adjuvant therapy should be considered when patients with grade 3 lung adenocarcinoma undergo R(un) lymphadenectomy.
本研究评估了新的肺腺癌分级系统对淋巴结清扫程度的预后影响。
我们分析了 2006 年至 2017 年间接受根治性切除术的 1258 例肺腺癌患者。我们分析了肿瘤分级和淋巴结清扫程度的总生存（OS）、癌症特异性生存（CSS）和无复发生存（RFS），分为 IASLC-R0（完全切除）或 R(un)（不确定切除）。
队列的中位年龄为 63 岁，41.9%为男性。大多数患者接受了肺叶切除术。肿瘤分布为 274 级 1 例、558 级 2 例和 426 级 3 例。中位随访时间为 102 个月后，10 年 OS/CSS/RFS 率在 1-3 级显著恶化：92.4%/99.3%/92.3%、77.8%/87.5%/71.7%和 63.6%/70.2%/52.0%，差异有统计学意义（p<0.001）。多变量 Cox 回归分析确定 3 级、R(un)淋巴结清扫、较高的 Charlson 合并症指数、吸烟史、开胸手术、较高的病理分期和血管淋巴管侵犯为 OS、CSS 和 RFS 降低的独立预后因素。此外，3 级患者从 IASLC-R0 淋巴结清扫中显著获益，与接受 R(un)淋巴结清扫的患者相比，OS 和 RFS 显著改善（OS 为 p=0.007，RFS 为 p=0.001，倾向评分匹配后）。在接受 R0 或 R(un)切除的 3 级肿瘤中，局部、远处和局部与远处同时复发的发生率分别为 8.5%比 13.7%、11.0%比 12.2%和 11.0%比 20.6%。
1-3 级肺腺癌的手术结果呈下降趋势。IASLC-R(un)治疗会恶化 3 级肺腺癌的 OS 和 RFS。当 3 级肺腺癌患者接受 R(un)淋巴结清扫时，应考虑加强监测和辅助治疗。
