Ⅰ期非小细胞肺癌肿瘤大小新分级探讨及生存相关因素分析

Analysis of Subclassif ication by Size and Survival-associated Factors of Stage Ⅰ Non-small Cell Lung Cancer

背景与目的第六版肿瘤,淋巴结,转移情况(TNM)分期中肿瘤大小(直径)仅以3cm为界限,难以精确阐明Ⅰ期肺癌不同肿瘤负荷对生存的影响。本研究主要探讨影响完全切除术后I期非小细胞肺癌(NSCLC)预后的各种临床病理因素,其中对Ⅰ期肺癌的肿瘤大小在现TNM分期的基础上做进一步亚分级并分析预后,以验证国际抗癌联合会(UICC)将要公布的新T-分期系统。方法回顾性分析327例肺癌患者的临床资料,采用Kaplan-Meier曲线和Log-rank时序检验生存率差异,通过比例风险模型(Cox模型)进行多因素分析。结果肿瘤低分化、中-高分化的5年生存率分别为60.49%和73.98%(P=0.0257);术前贫血者和无贫血者的5年生存率分别为64.44%和73.00%(P=0.0182);肿瘤直径≤2cm、2.1cm-3cm、3.1cm-5cm和5.1cm-7cm的5年生存率分别为86.30%、72.73%、62.50%和58.33%(P<0.0001)。结论患者的肿瘤分化级别、术前是否贫血及肿瘤大小(直径)是Ⅰ期行完全切除术后NSCLC独立的预后因素。肿瘤中-高分化、术前无贫血、肿瘤直径越小则Ⅰ期NSCLC患者的5年生存率更高,肿瘤大小在3cm基础上以2cm、5cm为界进一步分级,更能精确地体现其生存的变化,符合UICC将要公布的新T-分期系统。

Background and objective The sixth edition of TNM system is hard to illuminate the survival of different tumor load precisely. This retrospective study attempted to evaluate the prognostic clinicopathologic features of non-small cell lung cancer （NSCLC）. Especially we subclassified tumor sizes to validate the new T classification of international union against cancer （UICC）. Methods We reviewed the clinical data of 327 stage Ⅰ NSCLC with complete resection. Survival was analysed by Kaplan-Meier method and Log-rank test. The multivariate analysis was performed with Cox＇s proportion risk model. Results The S-year survival rate of poorly differentiated histologic grade and moderate-well differentiated histologic grade were 60.49% and 73.98% respectively （P=0.02574）; The 5-year survival rate of preoperative anemia or not were 64.44% and 73.00% （P=0.0182）; Tumor size was divided into 〈2 cm, 2.1 cm-3 cm, 3.1 cm-5 cm and 5.1 cm-7 cm with S-year survival rate of 86.30%, 72.73%, 62.50% and 58.33% respectively （P〈0.0001）. Conclusion Histologic grade, preoperative anemia and tumor size are the independent prognostic factors in complete resection of stage Ⅰ NSCLC. The patients with moderate-well differentiated histologic grade, non-preoperative anemia and smaller tumor size have longer survival time. Changes in tumor size classification are to subclassify into≤2 cm, 2.1 cm-3 cm, and 3.1 cm-5 cm, which is consistent with new T-staging system protocol of UICC.