背景:虽然内脏胸膜侵犯,淋巴管浸润,肿瘤通过空气空间扩散,分化差是肺腺癌患者预后不良的病理危险因素,这些因素对预后的累积影响尚不清楚.
方法:我们招募了1532例I期肺腺癌患者。根据危险因素的数量分为:A组(无危险因素),B组(一个风险因素),和C组(多种危险因素)。此外,我们根据肿瘤大小将患者分为两个亚组(≤3厘米,3-4厘米)。Kaplan-Meier分析用于评估5年无病生存期(DFS)和总生存期(OS)。
结果:总体而言,949、404和179名患者被纳入A组,B,C,分别。C组比其他组肿瘤体积更大,胸外复发病例更多。从A组到C组,5年DFS和OS逐渐下降(DFS:94.3%,80.6%,和64.3%,分别,p<0.001;OS:97.2%,92.7%,77%,分别,p<0.001)。对于大小≤3厘米的肿瘤,观察到类似的趋势(DFS:95.2%,83.2%,和68.5%,分别,p<0.001;OS:97.6%,94.1%,79.6%,分别,p<0.001),但是对于大小在3至4厘米之间的肿瘤,观察到的趋势不太明显(DFS:72.1,60.8和43.3%,分别,p=0.054;OS:85.7、82.1和64.7%,分别,p=0.16)。
结论:I期肺腺癌患者术后生存率随着病理危险因素的增加而恶化,尤其是肿瘤大小≤3cm的患者。
BACKGROUND: Although visceral pleural invasion, lymphovascular invasion, tumor spread through air spaces, and poor differentiation are pathological risk factors associated with unfavorable prognosis in patients with lung adenocarcinoma, the cumulative impact of these factors on prognosis remains unclear.
METHODS: We enrolled 1532 patients with stage I lung adenocarcinoma. Patients were divided according to the number of risk factors as follows: Group A (without risk factors), Group B (one risk factor), and Group C (multiple risk factors). Moreover, we stratified patients into two subgroups based on tumor size (≤ 3 cm, 3-4 cm). Kaplan-Meier analysis was used to evaluate 5-year disease-free survival (DFS) and overall survival (OS).
RESULTS: Overall, 949, 404, and 179 patients were included in Groups A, B, and C, respectively. Group C had a larger tumor size and more cases of extrathoracic recurrence than the other groups. The 5-year DFS and OS gradually decreased across Groups A to C (DFS: 94.3%, 80.6%, and 64.3%, respectively, p < 0.001; OS: 97.2%, 92.7%, and 77%, respectively, p < 0.001). A similar trend was observed for tumors ≤ 3 cm in size (DFS: 95.2%, 83.2%, and 68.5%, respectively, p < 0.001; OS: 97.6%, 94.1%, and 79.6%, respectively, p < 0.001), but a less pronounced trend was observed for tumors between 3 and 4 cm in size (DFS: 72.1, 60.8, and 43.3%, respectively, p = 0.054; OS: 85.7, 82.1, and 64.7%, respectively, p = 0.16).
CONCLUSIONS: Postoperative survival worsened with increasing pathological risk factors in patients with stage I lung adenocarcinoma, especially those with tumor size ≤ 3 cm.