We retrospectively collected patients who underwent lung surgery from 2018.8.1 to 2018.12.31 at our institution and diagnosed with lung adenocarcinoma pT1-2aN0M0 (stage I). Clinical data, manifestation on CT scan, pathologic features, driver gene mutations and follow-up information were collected. Cox proportional hazards regression analyses were performed utilizing the non-adjuvant cohort to predict disease free survival (DFS) and a nomogram was constructed and applied to the total cohort. Kaplan-Meier method was used to compare DFS between groups. Statistical analysis was conducted by R version 3.6.3.
A total of 913 stage I LUAD patients were included in this study. Median follow-up time is 48.1 months.4-year and 5-year DFS are 92.9 % and 89.6 % for the total cohort. 65 patient experienced recurrence or death. 4-year DFS are 97.0 %,94.6 % and 76.2 %, and 5-year DFS are 95.5 %, 90.0 % and 74.1 % in IASLC Grade1, 2 and 3, respectively(p < 0.0001). High-risk patients defined by single risk factors, such as, IASLC grade 3, pleura invasion, STAS, less LN resected could not benefit from adjuvant therapy. A LASSO-COX regression model was built and patients are divided into high-risk and low-risk groups. In the high-risk group, patients underwent adjuvant chemotherapy have longer DFS than those who did not (p = 0.024), while in the low-risk group, patients underwent adjuvant chemotherapy have inferior DFS than those who did not (p < 0.001).
IASLC grading is a significant indicator of DFS, however it could not guide adjuvant therapy in our stage I LUAD cohort. Growth patterns and T indicators together with other risk factors could identify high-risk patients that are potential candidate of adjuvant therapy, including some stage IA LUAD patients.
方法:我们回顾性收集了2018.8.1至2018.12.31在我们机构接受肺手术并诊断为肺腺癌pT1-2aN0M0(I期)的患者。临床数据,CT扫描的表现,病理特征,收集驱动基因突变和随访信息.使用非辅助队列进行Cox比例风险回归分析以预测无病生存(DFS),并构建列线图并应用于总队列。采用Kaplan-Meier法比较各组间DFS。通过R版本3.6.3进行统计学分析。
结果:本研究共纳入913例I期LUAD患者。中位随访时间为48.1个月,4年和5年DFS分别为92.9%和89.6%。65例患者出现复发或死亡。4年DFS为97.0%,94.6%和76.2%,5年期DFS为95.5%,在IASLC等级1、2和3中分别为90.0%和74.1%(p<0.0001)。由单一危险因素定义的高危患者,例如,IASLC3级胸膜侵犯,STAS,切除较少的LN不能从辅助治疗中获益。建立LASSO-COX回归模型,将患者分为高危和低危组。在高危人群中,接受辅助化疗的患者比没有接受辅助化疗的患者有更长的DFS(p=0.024),而在低风险组中,接受辅助化疗的患者的DFS低于未接受辅助化疗的患者(p<0.001).
结论:IASLC分级是DFS的重要指标,然而,在我们的I期LUAD队列中,它不能指导辅助治疗.生长模式和T指标以及其他危险因素可以确定高危患者是辅助治疗的潜在候选者。包括一些IALUAD期患者。