207例淋巴结阴性的早期非小细胞肺癌的临床病理特征及预后分析

Clinicopathologic and prognostic factors for 207 early-staged non-small cell lung cancer patients without lymph node metastasis

目的:对行手术切除的淋巴结阴性的早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的临床病理特征及影响术后生存预后因素进行分析。方法:纳入2008年1月至2013年12月于四川大学华西医院诊治,行手术切除且经病理确诊为非小细胞肺癌,肿瘤直径≤7cm,且无淋巴结及远处转移的患者,回顾性分析其一般临床特征以及术后生存预后的影响因素。结果:共纳入207例非小细胞肺癌患者,其中男性137例(66.2%),女性70例(33.8%);平均年龄60.1岁(38~80岁);有吸烟史患者113例(54.6%);病理类型以腺癌121例(58.5%)为主;病变部位主要位于肺上叶(右肺上叶65例,左肺上叶39例);有脏层胸膜浸润的肺癌患者101例(48.8%)。肿瘤直径≤3cm、>3~5cm和>5~7cm的患者五年生存率分别为80.0%、63.6%、41.5%。多因素分析提示年龄>65岁(HR:1.071,95%CI:1.026~1.118,P=0.001)、肿瘤直径≤3cm(HR:0.767,95%CI:0.630~0.930,P=0.007)及有脏层胸膜浸润(HR:2.058,95%CI:1.134~3.735,P=0.018)是影响淋巴结阴性的早期非小细胞肺癌患者生存预后的独立危险因素。结论:淋巴结阴性的早期非小细胞肺癌患者以男性居多,腺癌为主;肿瘤直径、患者年龄和脏层胸膜浸润是影响早期无淋巴结转移的肺癌患者的独立危险因素。

Objective： To study the clinicopathological characteristics and the prognostic factors of early-staged non-small cell lung cancer（NSCLC） patients without lymph node metastasis.Methods： We enrolled those NSCLC patients who underwent operation for p N0M0 stage,with tumor size lesser than 7cm from January 2008 to December2013.And we retrospectively recorded the following clinical pathologic factors： Age,gender,smoking status,histological type,maximum tumor size,VPI（presence or absence）,and we used the Kaplan-Meier method to analyse the survival.Results： We finally enrolled the data of 207 patients,male-to-female ratio was 1.96（137 /70） with a average age 60.1 years old（ranged from 38 to 80 years old）.The histological type was more likely to present with adenocarcinoma（121 patients,58.5%）,and the tumor site was more likely to be located on the upper lobe.There were101 patients（48.8%） with pathologically proven VPI.5-year survival rates for patients with tumor size lesser than〉3 cm, 3 - 5cm and 〉5 - 7cm were 80.0%,63.6%,41.5%,respectively.In multivariate analysis,age 〉65 years old（HR： 1.071,95% CI： 1.026 - 1.118,P = 0.001）,tumor size ≤3cm（HR： 0.767,95% CI： 0.630 - 0.930,P =0.007） and presence of VPI（HR： 2.058,95% CI： 1.134 - 3.735,P = 0.018） were independent risk factors for overall survival.Conclusion： Tumor size,presence of VPI,and age were independent risk factors for early-staged non-small cell lung cancer patients without lymph node metastasis.