不同肺腺癌分级评分系统在Ⅰ期肺腺癌预后评估中的意义

Prognostic significance of a newly proposed grading and scoring system in stage I pulmonary adenocarcinoma

目的评估国际肺癌研究协会／美国胸科学会／欧洲呼吸学会国际多学科肺腺癌分类（2011年版）分级评分系统（新分类分级评分系统）在Ⅰ期肺腺癌预后判断中的有效性和可行性，并将其与WHO分级系统进行比较。方法回顾性分析125例经外科治疗的Ⅰ期肺腺癌患者临床病理资料，以新分类为基础进行组织学分级（新分类分级），并在此基础上参照Sica等提出的分级评分的方法对这些病例进行评分（新分类评分），同时对病例按WHO分级系统分级，并分析各分级和评分病例的临床病理特征及预后。结果新分类分级评分系统与WHO组织学分级系统存在相关性（P=0．000），新分类分级（P=0．000）、新分类评分（P=0．000）以及WHO分级（P=0．020）均与总生存期存在负相关性，肿瘤的组织学级别或评分越高，生存期越短。以新分类分级（P=0．028）和评分（P：0．028）系统划分的各组患者间总生存期差异明显优于WHO分级系统（P=0．020）。另外与WHO分级系统（P=0．855）和新分类分级系统（P=0．073）相比，新分类评分系统与肿瘤的复发转移具有明确的正相关性（P=0．011），评分越高，肿瘤复发转移的几率越大。单因素方差分析结果显示：肿瘤大小（P=0．004）、临床分期（P=0．000）、WHO分级（P=0．020）、新分类分级（P：0．000）、新分类评分（P=0．000）、脉管侵犯（P=0．021）和复发转移（P=0．000）与预后相关。Cox多因素回归分析表明：临床分期（P=0．014）、新分类分级（P=0．047）、新分类评分（P=0．043）和复发转移（P=0．018）为独立预后因素，而肿瘤大小、WHO分级和脉管侵犯不能作为独立预后因素（P〉0．05）。结论新分类分级评分系统与WHO分级系统存在一定的相关性；但与WHO分级系统相比，以新分类为基础的肺腺癌分级评分系统对预测肺Ⅰ期腺癌的复发转移具有明显的优势，并能够反映其预后。

Objective To evaluate the prognostic significance of a new grading and scoring system （based on the new IASLC/ATS/ERS classification） in stage I pulmonary adenocarcinoma, as compared with the WHO grading system. Methods The clinicopathologic characteristics of 125 patients with stage I pulmonary adenocarcinoma primarily treated by surgical resection were reviewed retrospectively. All cases were classified according to the new IASLC/ATS/ERS classification and graded into three prognostic groups based on the new classification, the Sica scoring system and the WHO grading system, respectively. The differences in prognosis of the three groups were analyzed. Results There was a statistically significant correlation between the new grading system and the WHO grading system （ P = 0. 000）. Both of them showed negative correlation with overall survival. The new scoring system however better correlated with disease recurrence and/or metastasis （P =0. 855, P = 0. 073 versus P =0. 011 ）. According to univariate Log-rank test, the prognosis correlated with tumor size （P = 0. 004）, clinical stage （ P = 0. 000）, the WHO grading （P = 0. 020）, the new grading system （ P = 0. 000）, the new scoring system （P = 0. 000） , vascular invasion （P = 0. 021 ）, and recurrence and/or metastasis （P = 0. 000）. The Cox regression analysis demonstrated that clinical stage （P = 0. 014）, the new grading system （P = 0. 047 ）, the new scoring system （ P = 0. 043 ） , and recurrence and/or metastasis （ P = 0. 018 ） were significantly independent poor prognostic factors. Conclusions The new grading and scoring system shows good cmwelation with the WHO grading system. Compared with the WHO grading system, the new scoring system based on the new IASLC/ATS/ ERS classification provides valuable information in categorizing stage I pulmonary adenocarcinoma cases with different risks of disease recurrence, tumor metastasis and prognosis.