目的:最近的研究表明,血管浸润(V1)影响非小细胞肺癌(NSCLC)患者的长期生存。本研究的目的是强调V1是一个独立的危险因素。我们评估了V1对UICC分期I的NSCLC患者生存的影响。II,手术后的III。
方法:本回顾性研究包括2012年1月至2020年12月在我院接受解剖切除和根治性淋巴结清扫的747例NSCLC患者。将V1-与V0-患者(无血管侵犯)进行比较。所有患者在需要时根据欧洲指南接受辅助治疗。在排除检测到癌淋巴管病的患者后,切除边缘的肿瘤细胞,远处转移和那些,接受新辅助治疗的人,1-,采用Kaplan-Meier法评估3年和5年生存率。为了证明V1是一个独立的风险因素,对年龄进行了倾向评分匹配(PSM)分析,性别,UICC阶段,淋巴结受累,和合并症。
结果:本分析共纳入461例患者(V0:440;V1:21)。基线特征未显示任何显著差异。V0组的平均年龄为65.7±10.5岁,V1组的平均年龄为64.1±8.6岁(p值=0.5)。在V0组中,男性占54.8%,而在V1组中,该数字为66.7%(p值=0.37)。与V0组相比,V1组的平均生存期明显缩短(V1:45.8±9.3个月;V0:81.1±1.1个月;p值<0.001)。这在应用倾向评分匹配分析后得到证实(V0:99.9±4.9个月;V1:45.8±9.3个月;p值<0.001)-V1是独立于UICC分期的预后标志物。1-,V1患者的3年和5年生存率显着缩短(1年:V0:100%;V1:70.6%;p值=0.012)(3年:V0:95.2%;V1:46.2%;p值=0.002)(5年:V0:90.5%;V1:36.4%;p值=0.003)。
结论:正如我们的调查所表明的那样,V1对NSCLC患者的长期生存有重要影响,此外,作为一个独立的风险因素。由于我们的样本量虽小但指定,我们的陈述应该得到多中心研究的证实.同时,我们建议在肿瘤分类中强制实施V0/V1规范.
OBJECTIVE: Recent studies have shown that blood vessel invasion (V1) influences the long-term survival of patients with Non-Small Cell Lung Cancer (NSCLC). The aim of the present study was to emphasize V1 as an independent risk factor. We evaluated the effects of V1 on the survival of NSCLC patients with UICC stages I, II, and III after surgery.
METHODS: This retrospective study includes 747 consecutive patients with NSCLC who underwent anatomic resection and radical lymphadenectomy at our institution between January 2012 and December 2020. V1- were compared to V0-patients (no blood vessel invasion). All patients received adjuvant therapy according to European guidelines when indicated. After excluding patients with detection of lymphangiosis carcinomatosa, tumor-cells at the resection margin, distant metastases and those, that received neoadjuvant therapy, 1-, 3- and 5- year survival rates were assessed by Kaplan-Meier method. To proof V1 as an independent risk factor, a propensity score matched (PSM) analysis was performed regarding age, gender, UICC-stage, lymph-node involvement, and comorbidities.
RESULTS: A total of 461 patients (V0: 440; V1: 21) were included in this analysis. Baseline characteristics did not show any significant difference. Mean age in V0-group was 65.7 ± 10.5 years and 64.1 ± 8.6 years in V1-group (p-value = 0.5). In the V0-group 54.8% were male, whereas in the V1-group this number was 66.7% (p-value = 0.37). Mean survival in V1-group was significantly shorter compared to V0-group (V1: 45.8 ± 9.3 months; V0: 81.1 ± 1.1 months; p-value<0.001). This was confirmed after applying a propensity score matched analysis (V0: 99.9 ± 4.9 months; V1: 45.8 ± 9.3 months; p-value<0.001) - V1 is a prognostic marker independent of UICC stage. The 1-, 3- and 5-year survival rates were significantly shorter for V1-patients (1-year: V0: 100%; V1: 70.6%; p-value = 0.012) (3-year: V0: 95.2%; V1: 46.2%; p-value = 0.002) (5-year: V0: 90.5%; V1: 36.4%; p-value = 0.003).
CONCLUSIONS: As we have shown with our investigations, V1 has a major impact on long-term survival in NSCLC patients and furthermore, acts as an independent risk factor. Due to our small but specified sample size, our statement should be confirmed by a multicenter study. In the meantime, we suggest making the implementation of the V0/V1 specification mandatory in the tumor classification.