Ichinose Y, Yano T, Asoh H, Yokoyama H, Yoshino I, Katsuda Y
Department of Chest Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
J Thorac Cardiovasc Surg. 1995 Sep;110(3):601-5. doi: 10.1016/S0022-5223(95)70090-0.
We attempted to clarify what factors predominantly influence the survival of patients with non-small-cell lung cancer in each pathologic stage on the basis of information generally obtained by a pathologic examination of completely resected non-small-cell lung cancer. The subjects included 243 patients with stage I, 63 with stage II, and 108 with stage IIIA disease. Pathologic features used in the analysis were as follows: the greatest tumor size (< or = 3.0 cm versus > 3.0 cm), the histologic cell type (squamous versus nonsquamous cell carcinoma), the grade of differentiation, and tumor invasion of pleura and vessels. In stage IIIA, the extent of the metastasis to the lymph nodes was also included in the analysis. The significant prognostic factors (p < 0.05) in stage I demonstrated by a univariate analysis of the survival curves included the tumor size, the grade of differentiation (well differentiated versus moderately and poorly differentiated tumor), pleural involvement, and invasion of the artery and vein. In addition, the histologic cell type and the pleural involvement in stage II and invasion of the vein and the extent of metastasis to the lymph nodes (N0 and N1 versus N2) in stage IIIA were also found to be significant prognostic factors. A multivariate prognostic factor analysis showed that the grade of differentiation, pleural involvement, and venous invasion in stage I; the histologic cell type and pleural involvement in stage II; and venous invasion and mediastinal lymph node metastasis in stage IIIA were all predominant prognostic factors. These observations therefore suggest that a pathologic examination can identify the patients with a poor prognosis, which is different among the stages.
我们试图根据对完全切除的非小细胞肺癌进行病理检查通常所获得的信息，阐明在每个病理阶段主要影响非小细胞肺癌患者生存的因素。研究对象包括243例I期患者、63例II期患者和108例IIIA期患者。分析中使用的病理特征如下：最大肿瘤大小（≤3.0 cm与>3.0 cm）、组织学细胞类型（鳞状细胞癌与非鳞状细胞癌）、分化程度以及肿瘤对胸膜和血管的侵犯。在IIIA期，还将淋巴结转移程度纳入分析。通过生存曲线单因素分析显示，I期的显著预后因素（p<0.05）包括肿瘤大小、分化程度（高分化肿瘤与中低分化肿瘤）、胸膜受累以及动静脉侵犯。此外，II期的组织学细胞类型和胸膜受累以及IIIA期的静脉侵犯和淋巴结转移程度（N0和N1与N2）也被发现是显著的预后因素。多因素预后因素分析表明，I期的分化程度、胸膜受累和静脉侵犯；II期的组织学细胞类型和胸膜受累；以及IIIA期的静脉侵犯和纵隔淋巴结转移均为主要预后因素。因此，这些观察结果表明病理检查可以识别预后不良的患者，而各阶段的预后不良情况有所不同。
