Muñoz-Molina Gemma-María, Fra-Fernández Sara, Cabañero-Sánchez Alberto, Rojas-Tula Diego Germán, Cavestany-García-Matres Cristina, Muriel-García Alfonso, Caballero-Silva Usue, Gorospe-Sarasúa Luis, Saldaña-Garrido David, Benito-Berlinches Amparo, Moreno-Mata Nicolás
Thoracic Surgery Department, Ramon y Cajal Hospital, Spain.
Thoracic Surgery Department, Ramon y Cajal Hospital, Spain.
Arch Bronconeumol. 2025 Jun;61(6):341-347. doi: 10.1016/j.arbres.2024.11.006. Epub 2024 Nov 22.
Expanding TNM staging system for lung cancer with the addition of new prognostic factors could enhance patient stratification and survival prediction. The goal of this study is to assess if TNM prognosis capacity could be improved by incorporating other pathological characteristics of surgical specimen.
We retrospectively reviewed lung cancer resections, stages I-II, performed between January 1st 2010 and May 1st 2019. We collected clinical variables and pathological characteristics, including vascular, lymphovascular and perineural invasion, STAS, necrosis and stromal features. Mortality and recurrence-free survival were assessed with univariable and multivariable Cox analysis. We explored how these factors would modify the TNM Harrel's index.
629 tumors were analyzed. Median overall survival was 53.9 months. Median recurrence-free survival was 47.6 months. Specific survival at 3, 5 and 10 years was 90, 83 and 74%. Recurrence-free survival at 3, 5 and 10 years was 76, 70 and 65%. The multivariable analysis showed that overall survival was significantly related to TNM classification (p<0.0002), vascular infiltration (HR 1.93, CI 1.42-2.64, p<0.0001), lymphovascular invasion (HR 1.88, CI 1.30-2.71, p<0.0015) and necrosis (HR 1.74, CI 1.24-2.45, p<0.0025). Harrell's index for TNM was 0.6139. Adding vascular, lymphovascular invasion and necrosis, it increased up to 0.6531. The multivariable analysis showed that specific survival was significantly related to TNM classification (p<0.001), vascular infiltration (HR 2.23, CI 1.44-3.46, p<0.001) and lymphovascular invasion (HR 1.85, CI 1.09-3.13, p<0.021). Harrell's index for TNM was 0.6645. Adding vascular and lymphovascular invasion, it increased up to 0.7103. Recurrence-free survival was related to TNM, vascular infiltration (HR 1.48, CI 1.05-2.09, p<0.023) and lymphovascular invasion (HR 2.40, CI 1.64-3.50, p<0.001). Harrell's index for TNM was 0.6264. Adding vascular and lymphovascular invasion, it increased up to 0.6794.
Including vascular and angiolymphatic invasion in the staging system classification could better stratify patients at risk of recurrence and tumor-related death.
通过增加新的预后因素来扩展肺癌的TNM分期系统，可提高患者分层和生存预测能力。本研究的目的是评估纳入手术标本的其他病理特征是否能改善TNM的预后能力。
我们回顾性分析了2010年1月1日至2019年5月1日期间进行的I-II期肺癌切除术。我们收集了临床变量和病理特征，包括血管、淋巴管和神经周围浸润、STAS、坏死和间质特征。采用单变量和多变量Cox分析评估死亡率和无复发生存率。我们探讨了这些因素如何改变TNM的Harrel指数。
共分析了629例肿瘤。中位总生存期为53.9个月。中位无复发生存期为47.6个月。3年、5年和10年的特定生存率分别为90%、83%和74%。3年、5年和10年的无复发生存率分别为76%、70%和65%。多变量分析显示，总生存期与TNM分类显著相关（p<0.0002）、血管浸润（HR 1.93，CI 1.42-2.64，p<0.0001）、淋巴管浸润（HR 1.88，CI 1.30-2.71，p<0.0015）和坏死（HR 1.74，CI 1.24-2.45，p<0.0025）。TNM的Harrel指数为0.6139。加入血管、淋巴管浸润和坏死因素后，该指数增至0.6531。多变量分析显示，特定生存率与TNM分类显著相关（p<0.001）、血管浸润（HR 2.23，CI 1.44-3.46，p<0.001）和淋巴管浸润（HR 1.85，CI 1.09-3.13，p<0.021）。TNM的Harrel指数为0.6645。加入血管和淋巴管浸润因素后，该指数增至0.7103。无复发生存率与TNM、血管浸润（HR 1.48，CI 1.05-2.09，p<0.023）和淋巴管浸润（HR 2.40，CI 1.64-3.50，p<0.001）相关。TNM的Harrel指数为0.6264。加入血管和淋巴管浸润因素后，该指数增至0.6794。
在分期系统分类中纳入血管和血管淋巴管浸润可更好地对有复发风险和肿瘤相关死亡风险的患者进行分层。
