Ⅰ期非小细胞肺癌术后预后的多因素分析

Multivariate Survival Analysis of Patients with Stage I NSCLC

背景与目的Ⅰ期患者尤其是Ib期术后非小细胞肺癌(non-small cell lung cancer,NSCLC)患者能否从辅助化疗中获益备受争议。2009年第7版肺癌TNM分期发表。本研究的目的是明确新版TNM分期对Ⅰ期NSCLC患者的价值,以及评估术后辅助化疗是否能提高早期肺癌患者的生存率。方法研究纳入了上海市胸科医院1998年6月-2010年6月早期NSCLC完全切除术的433例患者,按照新的分期标准重新分期。把新分期的参数与其它已被证明与肺癌预后相关的因子结合起来,进行多因素分析。研究纳入变量包括年龄、性别、吸烟史、病理类型、手术切除方式(叶切、双叶切、袖切和全切)、肿瘤大小(肿瘤最长径)、T分期、淋巴管血管癌栓和辅助化疗结果女性患者3年生存率优于男性(89.22%vs 77.53%,P=0.001,8)。老年患者预后不佳,≥70岁的NSCLC患者3年生存率为70.64%,<70岁为85.85%,P=0.000,1)。肿瘤最长径≤2 cm患者的3年生存率优于>2cm且≤3 cm患者(95.15%vs85.71%),肿瘤最长径>3 cm且≤5 cm及>5 cm且≤7 cm者3年生存率为74.80%vs 60.47%(P<0.000,1)。多因素分析显示年龄、性别、血管癌栓、病理类型、胸膜侵犯是影响生存期的预后因素。结论对Ⅰ期NSCLC患者而言,肿瘤最长径及病理类型是独立的预后因素。腺癌患者的生存期优于其它病理类型。女性和非吸烟患者结局较好。Ib期患者可能从术后辅助化疗中获益。

Background and objective The effectiveness of adjuvant chemotherapy in providing survival advantage for stage I non-small cell lung cancer（NSCLC） patients,especially those with stage Ib NSCLC,remains to be determined.The seventh edition of the Tumor Node Metastasis（TNM） Classification of Malignant Tumors is due to be published in 2009. The aim of the current study is to validate the value of this classification in Chinese early-stage NSCLC.The benefits of adjuvant chemotherapy to patients with early-stage NSCLC were also assessed.Methods The new staging project was validated in 433 patients who underwent complete surgical resection for early-stage NSCLC at the Single Institution of Shanghai Chest Hospital from June 1998 to June 2010.This new parameter was combined with other well-established prognostic factors,and multivariate survival analysis were performed.Variables in the analysis included age,gender,history of smoking,pathologic type,type of resection（pneumonectomy,lobectomy,bilobectomy,and sleeve resection）,tumor size（largest tumor dimension）, T-status,lymphovascular vessel invasion,and adjuvant chemotherapy.Results The three-year overall survival rates for females and males are 89.22%and 77.53%,respectively（P=0.001,8）.Elder patients have worse prognoses：the survival rates for those aged 70 and 70 are 70.64%and 85.85%,respectively（P=0.000,l）.The three-year overall survival rates of patients whose tumors measured no larger than 2 cm in biggest diameter or larger than 2 cm but no larger than 3 cm are 95.15%and 85.71%,respectively.For those with tumors larger than 3 cm but smaller than 5 cm or larger than 5 cm but smaller than 7 cm, the survival rates are 74.80%and 60.47%,respectively（P0.000,1）.Multivariate analysis reveals that age,gender,vascular vessel invasion,pathologic type,and visceral pleural involvement are significant predictive factors of the overall survival.Conclusion The tumor size and pathologic type are significant independent prognostic factors in stage I NSCLC.The survival rates of patients with adenocarcinoma are higher than those of patients with other types of NSCLC.Female patients and those without a history of smoking have a better outcome.Results suggest that patients with the Ib stage of the disease can benefit from adjuvant chemotherapy.