早期肺腺癌患者预后及早期复发病理特征的研究
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摘要
目的术后复发转移是早期肺腺癌治疗失败的主要原因,探寻其临床病理特征有利于筛选预测复发转移的高危患者。方法随访分析157例手术治疗、病理确诊为早期肺腺癌患者的整体复发及生存时间,重点探讨早期复发患者的临床病理特征。结果 157例早期肺腺癌患者的中位无复发生存(RFS)时间为55.0个月,1、2和5年RFS率分别为86.0%、75.8%和45.0%;总生存率分别为98.1%、96.0%和84.1%。157例早期肺腺癌患者中,69例复发转移,其中1年内早期复发者为22例(14.0%)。统计分析结果显示,肿瘤大小、组织学亚型是影响早期肺腺癌术后患者RFS的危险因素(P<0.05),低分化和非贴壁为主型可能是早期复发患者的病理学特征。结论肿瘤直径大于2cm、非贴壁为主型和低分化可能是预测早期肺腺癌复发与早期复发的重要因素。
Objective Postoperative recurrence and metastasis are the main causes for failure treatment in early lung adenocarcinoma.Exploring the clinicopathological features is beneficial for screening out the patients with high-risk recurrence and metastasis.Methods A total of 157 surgical patients were diagnosed as early lung adenocarcinoma in pathology and their recurrence and survival time were followed up and analyzed.The clinicopathological features of patients with early recurrence were particularly explored.Results The median recurrence free survival(RFS)period of 157 patients with early lung adenocarcinoma was 55.0 months.The 1-,2-and 5-year RFS rate was 86.0%,75.8%,and 45.0%,respectively;the overall survival rate was98.1%,96.0% and 84.1%,respectively.Of the 157 early lung adenocarcinoma patients,69 cases had recurrence and metastasis,of which 22 cases had early recurrence within 1 year(14.0%).Statistical analysis showed that tumor size and histological types were the risk factors affecting RFS in patients with early lung adenocarcinoma(P<0.05).Poor-differentiated and non-adherent predominant type might be the pathological features of patients with early recurrence.Conclusion Tumor size>2 cm,poor-differentiated and non-adherent predominant type may be important factors in predicting recurrence and early recurrence for early lung adenocarcinoma.
Objective Postoperative recurrence and metastasis are the main causes for failure treatment in early lung adenocarcinoma.Exploring the clinicopathological features is beneficial for screening out the patients with high-risk recurrence and metastasis.Methods A total of 157 surgical patients were diagnosed as early lung adenocarcinoma in pathology and their recurrence and survival time were followed up and analyzed.The clinicopathological features of patients with early recurrence were particularly explored.Results The median recurrence free survival(RFS)period of 157 patients with early lung adenocarcinoma was 55.0 months.The 1-,2-and 5-year RFS rate was 86.0%,75.8%,and 45.0%,respectively;the overall survival rate was98.1%,96.0% and 84.1%,respectively.Of the 157 early lung adenocarcinoma patients,69 cases had recurrence and metastasis,of which 22 cases had early recurrence within 1 year(14.0%).Statistical analysis showed that tumor size and histological types were the risk factors affecting RFS in patients with early lung adenocarcinoma(P<0.05).Poor-differentiated and non-adherent predominant type might be the pathological features of patients with early recurrence.Conclusion Tumor size>2 cm,poor-differentiated and non-adherent predominant type may be important factors in predicting recurrence and early recurrence for early lung adenocarcinoma.
引文
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[2]YANAGAWA N,SHIONO S,ABIKO M,et al.New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stageⅠlung adenocarcinoma[J].J Thorac Oncol,2013,8(5):612-618.
[3]OKADA M,NISHIO W,SAKAMOTO T,et al.Effect of tumor size on prognosis in patients with non-small cell lung cancer:the role of segmentectomy as a type of lesser resection[J].J Thorac Cardiovasc Surg,2005,129(1):87-93.
[4]YANG X,LIU Y,LIAN F,et al.Lepidic and micropapillary growth pattern and expression of napsin A can stratify patients of stageⅠlung adenocarcinoma into different prognostic subgroup[J].Int J Clin Exp Pathol,2014,7(4):1459-1468.
[5]UJIIE H,KADOTA K,CHAFT J E,et al.Solid predominant histologic subtype in resected stageⅠlung adenocarcinoma is an independent predictor of early,extrathoracic,multisite recurrence and of poor postrecurrence survival[J].J Clin Oncol,2015,33(26):2877-2884.
[6]OU S H,ZELL J A,ZIOGAS A,et al.Prognostic factors for survival of stageⅠnonsmall cell lung cancer patients:apopulation-based analysis of 19,702stageⅠpatients in the California Cancer Registry from 1989to 2003[J].Cancer,2007,110(7):1532-1541.
[7]QIAN H H,XU T S,CAI X Q,et al.Prognostic value of TTF-1expression in patients with non-small cell lung cancer:a Meta-analysis[J].Clin Chim Acta,2015,451(Pt B):208-214.
[8]HUANG T W,LIN K F,LEE C H,et al.The role of thyroid transcription factor-1and tumor differentiation in resected lung adenocarcinoma[J].Sci Rep,2017,7(1):14222.
[9]KOZU Y,MANIWA T,TAKAHASHI S,et al.Risk factors for both recurrence and survival in patients with pathological stageⅠnon-small-cell lung cancer[J].Eur JCardiothorac Surg,2013,44(1):e53-e58.
[10]VANSTEENKISTE J,CRINO L,DOOMS C,et al.2nd ESMO consensus conference on lung cancer:early-stage non-small-cell lung cancer consensus on diagnosis,treatment and follow-up[J].Ann Oncol,2014,25(8):1462-1474.
[11]PADDA S K,BURT B M,TRAKUL N,et al.Early-stage non-small cell lung cancer:surgery,stereotactic radiosurgery,and individualized adjuvant therapy[J].Semin Oncol,2014,41(1):40-56.
[12]BURDETT S,PIGNON J P,TIERNEY J,et al.Adjuvant chemotherapy for resected early-stage non-small cell lung cancer[J].Cochrane Database Syst Rev,2015,1816(3):D11430.