不同病理分型对Ⅰ期肺腺癌预后的影响

Analysis of the effect of different pathological subtypes to prognosis in stage Ⅰ pulmonary adenocarcinoma

目的 分析国际肺癌研究协会、美国胸科学会及欧洲呼吸学会提出的肺腺癌新分类对Ⅰ期肺腺癌预后的价值.方法 复习复旦大学附属中山医院胸外科2005年1月至2009年12月连续328例Ⅰ期浸润性肺腺癌患者的病理学切片.其中男性145例,女性183例;年龄34～82岁,平均年龄（59＆#177;10）岁.根据新分类重新读片分型并记录＞5％的成分,采用Kaplan-Meier法比较不同患者生存情况,采用Cox回归分析寻找预后风险因素.结果 贴壁为主型患者5年总体生存率和5年无进展生存率均为100％.有微乳头成分患者5年无进展生存率（49.3％）明显低于无微乳头成分患者（75.4％,x2=8.154,P=0.004）.回归分析结果显示,肿瘤大小是肿瘤复发（HR=1.796,95％ CI：1.469～2.198,P=0.000）和患者死亡（HR=1.967,95％ CI：1.507～2.567,P=0.000）的独立预后因素.亚组分析结果显示,ⅠB期患者肿瘤复发的独立预后因素是存在实体成分（HR=1.985,95％ CI：1.013 ～3.888,P=0.046）和肿瘤大小（HR=1.941,95％ CI：1.455～2.589,P=0.000）.结论 新的病理分型在Ⅰ期肺腺癌中具有一定预后价值,实体成分和微乳头成分能对预后产生一定影响,详细记录肿瘤中各种成分非常重要.

Objective To analyze the prognostic value of the new classification （proposed by International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society） in stage Ⅰ pulmonary adenocarcinoma.Methods Pathological slides of 328 cases of stage Ⅰ pulmonary invasive adenocarcinoma were reviewed according to the new classification.The patients received operation in Department of Thoracic Surgery of Zhongshan Hospital affiliated to Fudan University from January 2005 to December 2009.There were 145 male and 183 female patients with an average age of （59 ＆#177; 10） years （ranging from 34 to 82 years）.Clinical,pathological,and survival data were retrospectively analyzed.Kaplan-Meier method was used for analysis of survival,and Cox regression analysis was used for finding out prognostic factors.Results Five-year progression-free survival rate and overall survival rate of lepidic-predominant subtype were both 100%.Five-year progression-free survival rate of patients with micropapillary component （49.3%） was significantly lower than that of patients without micropapillary component （75.4%,x2 =8.154,P =0.004）.Regression analysis showed that tumor size is an independent prognostic factor of death （HR =1.967,95% CI：1.507 to 2.567,P =0.000） and recurrence （HR =1.796,95% CI：1.469 to 2.198,P =0.000）.In subgroup analysis,the presence of solid component （HR =1.985,95% CI：1.013 to 3.888,P =0.046） and tumor size （HR =1.941,95% CI：1.455 to 2.589,P =0.000） were independent prognostic factors of recurrence for stage Ⅰ B pulmonary adenocarcinoma.Conclusions The new classification of adenocarcinoma is of prognostic value in stage Ⅰ pulmonary adenocarcinoma.The presence of solid or micropapillary component impacts on survival.Detailed record of each component in tumor is necessary.