T1aN0M0期浸润性肺腺癌术后复发的危险因素分析

Risk factors of recurrence for resected T1aN0M0 invasive lung adenocarcinoma：a clinicopathologic study of 177 patients

目的 探讨完整切除的病理分期为T1aN0M0的肺腺癌术后复发的危险因素.方法 分析177例接受肺叶切除的T1aN0M0浸润性肺腺癌病例,根据国际肺腺癌新病理分型系统（IASLC/ATS/ERS）进行重新分型.分析年龄、性别、吸烟史、淋巴血管浸润（LVI）、新病理分型与无复发生存（RFS）率的关系,统计学分析使用Log-rank检验和Cox回归.结果 总体5年无复发生存率为83.7％.LVI和新病理分型与5年无复发生存率有相关（P＜0.05）.低危组中的乳头状、鳞屑样、腺泡样为主型的预后显著优于高危组中的混合乳头状、实性和微乳头状为主型.男性患者中高危组的患者更多[校正比值比（OR）：2.214,95％可信区间（CI）：1.050 -4.668,P＜0.05],且LVI有相对更多的趋势（校正OR：2.091,95％ CI：0.938 -4.662,P＞0.05）.结论 IASLC/ATS/ERS新病理分型中的实性和微乳头状为主型是T1aN0M0期肺腺癌术后复发的唯一危险因素,提示这类肿瘤的生物学行为更具侵袭性.

Objective To identify risk factors of recurrence for completely resected pathologic T1aN0M0 lung adenocarcinomas.Methods We reviewed the records of 177 T1aN0M0 invasive adenocarcinoma patients,and re-classified achieved surgical specimens according to the new International Association for the Study of Lung Cancer （IASLC）/American Thoracic Society （ATS）/European Respiratory Society （ERS） lung adenocarcinoma classification.Impact on recurrence-free survival （RFS） of age,gender,smoking history,lymphovascular invasion （LVI） and new classification was analyzed by Log-rank test and Cox regression.Results The 5-year recurrence-free rate was 83.7％.The LVI and new adenocarcinoma classification were significantly associated with 5-year RFS （P ＜ 0.05,respectively）.This high-grade group is associated with significantly more male gender [adjusted OR：2.214,95％ confidence interval （CI）：1.050-4.668,P ＜0.05],and borderline significantly the presence of LVI （adjusted OR：2.091,95％ CI：0.938-4.662,P ＞ 0.05）.Conclusion Our results showed that the solid-and micropapillary predominant subtype of IASLC/ATS/ERS classification remains the only risk factor for post-operative recurrence of T1aN0M0 adenocarcinomas,suggesting that they can be indicators of aggressive tumor behaviors.