脏层胸膜受侵对Ib期非小细胞肺癌预后的影响

Impact of visceral oleural invasion on the prognosis of stage I b non-small cell lung cancer

目的探讨脏层胸膜受侵对Ib期非小细胞肺癌预后的影响。方法回顾性分析1994年1月至2003年12月间在我院接受手术切除的232例Ib期非小细胞肺癌（NSCLC）患者的临床和随访资料。根据肿瘤大小和脏层胸膜受侵情况，将患者分为3组，A组：肿瘤最大径〉3cm且无脏层胸膜受侵；B组：肿瘤最大径≤3cm且脏层胸膜受侵；C组：肿瘤最大径〉3cm且脏层胸膜受侵。运用Kaplan-Meier生存分析和Cox比例风险模型，对影响NSCLC预后的因素进行分析。结果A组45例，B组96例，C组91例，其5年生存率分别为70．1％、61．9％和56．2％，10年生存率分别为56．7％、50．6％和35．9％，3组生存率之间的差异有统计学意义（P=0．018）。脏层胸膜受侵者187例（80．6％），5年和10年生存率分别为59．3％和42．6％；无脏层胸膜受侵者45例（19．4％），5年和10年生存率分别为70．1％和56．7％，两组生存率之间的差异有统计学意义（P=0．035）。多因素分析显示，以肿瘤大小和脏层胸膜受侵情况分组为变量，是影响预后的因素（RR=1．530，95％CI为1．132～2．067，P=0．006）。结论Ib期NSCLC中，不同T状态患者生存率之间的差异有统计学意义，肿瘤最大径〉3cm脏层胸膜受侵的患者预后较差，这一T2状态是否需要修改有待进一步的研究。

Objective To investigate the impact of visceral pleural invasion （VPI） on prognosis and staging in patients with stage I b non-small cell lung cancer （NSCLC）. Methods Clinical data of 232 patients with stage Ib NSCLC surgically treated by curative resection between January 1994 and December 2003 was retrospectively reviewed. Histopathological diagnosis was reviewed by an experienced pathologist. According to the tumor size and status of VPI, patients were stratified into three group ： group A ： tumor 〉 3 cm and VPI（ - ） ; group B：tumor≤3 cm and VPI（ ＋ ） ;group C：tumor 〉3 cm and VPI（ ＋ ）. There were 45 patients in group A, 96 in group B and 91 in group C. Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis. Results 187 （ 80.6% ） patients had visceral plural invasion, while 45（ 19.4% ） had no. The 5-and 10-year survival rates of patients with VPI were 59.3% and 42.6%, while it was 70. 1% and 56.7% for the patients without （P = 0.035）, respectively. The 5-year survival rates of patients in group A, B and C were 70.1%, 61.9% and 56.2% ; and 10-years survival rates were 56.7%, 50.6% and 35.9%, respectively （ P = 0.018 ）. VPI with large size of tumor was revealed by Cox multivariate analysis as an independent prognostic factor （RR = 1. 530, 95% CI： 1. 132-2.067, P =0.006）. Conclusion A significant difference in survival exists among the stage I b NSCLC patients who have different T status, the patient with 〉 3 cm tumor and visceral plural invasion may have the worst prognosis. Further studies are still needed to assess whether it is necessary or not to modify the T2 statue of tumor 〉 3 cm with visceral plural invasion.