术后放疗对局部晚期伴微乳头型肺腺癌的预后价值

Prognostic value of postoperative radiotherapy for locally advanced pulmonary adenocarcinoma with micropapillary pattern

目的 探讨术后放疗对局部晚期伴微乳头型肺腺癌（MPPAC）预后的影响.方法 回顾性分析天津医科大学肿瘤医院2012年1月至2014年12月根治性切除术后,经病理诊断为MPPAC的45例PN2-3期患者临床资料.根据术后是否行放射治疗分为放疗组和未放疗组.比较两组患者的一般情况及总生存和无病生存情况.结果 全组患者的中位总生存期（overall survival, OS）为19.8个月,1年及2年总生存率分别为79.4％和30.3％.全组患者的中位无进展生存期（disease free survival,DFS）为13个月,1年及2年无进展生存率分别为59.3％和28.9％.放疗组和未放疗组患者的中位OS分别为22.3和13.4个月（χ^2=13.329,P＜0.05）,中位DFS分别为16.2和10.4个月（χ^2=7.972,P＜0.05）.全组患者表皮生长因子受体（EGFR）基因突变率57.14％ （20/35）.亚组分析发现,对于EGFR突变患者,放疗组和未放疗组中位OS分别为25.6和18.4个月（χ^2 =9.268,P＜0.05）,中位DFS分别为21.6和12.6个月（P＞0.05）;对于无EGFR突变的患者,放疗组和未放疗组中位OS分别为21.8和10.6个月（χ^2=9.595,P＜0.05）,中位DFS分别为15.2和6.6个月（χ^2=4.538,P＜0.05）.结论 PORT能够改善根治术后pN2.3期MPPAC患者生存,局部晚期根治术后的MPPAC患者仍需PORT.

Objective To investigate the prognostic significance of postoperative radiotherapy （PORT） for locally advanced pulmonary adenocarcinoma with micropapillary pattern（MPPAC）.Methods A total of 45 completely resected pN2-3 cases that occured from January 2012 to December 2014 at Tianjin Medical University Cancer Hospital were retrospectively analyzed.All of them were diagnosed with MPPAC by pathological diagnosis.Based on whether receiving PORT, patients were divided into radiotherapy and non-radiotherapy groups.General characteristics, overall survival and disease-free survival characteristics of the two groups were compared, respectively.Results The median overall survival （OS） of patients was 19.8 months, 1-year and 2-year overall survival rate was 79.4% and 30.3% , respectively.The median disease free survival （DFS） of patients was 13 months, 1-year and 2-year, and the disease free survival rate was 59.3% and 28.9% , respectively.The radiotherapy and non-radiotherapy groups exhibited median OS of 22.3 and 11.4 months,respectively （χ^2=13.329, P〈 0.05） , and corresponding D FS of 16.2 and 10.4 months（χ^2 =7.972 ,P 〈0.05）.The epidermal growth factor receptor gene （EGFR） mutation rate of patients was 57.14% （20/35）, In the subgroup analysis, for patients with EGFR mutation, the radiotherapy and non-radiotherapy groups showed median OS of 25.6 and 18.4 months, respectively（χ^2 =9.268,P 〈 0.05） , and corresponding DFS of 21.6 and 12.6 months （P 〉 0.05）.For patients with wildtype EGFR, the radiotherapy and non-radiotherapy groups showed median OS of 21.8 and 10.6 months,respectively（χ^2 =9.595,P 〈 0.05） , and corresponding DFS of 15.2 and 6.6 months（χ^2 =4.538,P 〈0.05）.Conclusions PORT could improve survival of patients with pN2.3 MPPAC.For patients with locally advanced MPPAC after curative resection, PORT is still an integral part of treatment.