原发性肺腺癌组织亚型及预后

The histological subtype and prognosis of the surgically resected primary lung adenocarcinoma

目的分析河南地区原发性肺腺癌患者手术切除标本的组织亚型及预后。方法收集2013—2014年郑州大学第一附属医院的438例原发性肺腺癌患者手术切除标本,按照2015年WHO肺肿瘤分类方法分析组织亚型,采用Cox比例风险回归模型分析组织亚型对预后的影响作用。结果占主要成分的组织亚型中,最多见的是乳头型(37.4%);其他依次为实体型(24.7%),腺泡型(21.2%),浸润黏液型(7.8%),微乳头型(5.3%),贴壁型3.7%(16/348)。根据Cox模型,在单变量分析中,性别(P=0.009,RR=1.878,95%CI:1.174~3.005)、吸烟情况(P=0.008,RR=1.842,95%CI:1.172~2.890)、肿瘤部位(P=0.000,RR=3.960,95%CI:2.177~7.204)、肿瘤最大径(P=0.000,RR=2.779,95%CI:1.743~4.431)、组织亚型(P=0.000,RR=3.356,95%CI:2.134~5.270)是术后生存期的预测因子。多变量分析中,肿瘤最大径(P=0.002,RR=2.154,95%CI:1.341~3.460)、组织亚型(P=0.000,RR=2.717,95%CI:1.714~4.307)、肿瘤部位(P=0.000,RR=3.796,95%CI:2.079~6.932)是术后生存期的预测因子。结论组织亚型是肺腺癌预后的独立预测指标,可以指导临床患者生存期预测和精准治疗方案的制定。

Objective To investigate the histological subtype and prognosis of primary lung adenocarcinoma in Henan Prov- ince. Methods 438 patients with primary lung adenocarcinoma were retrospectively reviewed, who underwent surgically resec- tion from 2013 to 2014 in the First Affiliated Hospital of Zhengzhou University. The tumors were classified according to the 2015 WHO classification of tumors of the lung, pleura, thymus and heart classification. The affect of the histological subtypes on the prognosis was analyzed by using Cox＇ s proportional hazards regression model. Results The dominant histological subtypes were papillary（37.4% ）, solid（24. 7% ）, acinar（21.2% ）, mucinous（7. 8% ）, micropapillary（5. 3% ） and lepidic（ 3. 7% ） arang- ing from high to low. According Cox model ： gender （ P = 0. 009, RR = 1. 878, 95% CI： 1. 174 - 3. 005 ）, smoking history （ P = 0. 008, RR = 1. 842, 95% CI： 1. 172 -2. 890）, tumor location （P =0. 000, RR =3.960, 95% CI： 2. 177 -7. 204）, the tumor maximum diameter （P = 0. 000, RR = 2. 779, 95% CI： 1. 743 - 4. 431 ）, the histological subtypes （ P = 0. 000, RR = 3. 356, 95% CI： 2. 134-5. 270） were predictors of the prognosis in the univariate model. The tumor maximum diameter （P =0. 002, RR =2. 154, 95% CI： 1. 341 -3. 460）, the histological subtypes （P =0. 000, RR =2. 717, 95% CI： 1.71 -4. 307）, tumor lo- cation （ P = 0. 000, RR = 3. 796, 95% CI： 2. 079 - 6. 932） were predictors of the prognosis in the multivariate model. Conclu- sion The histological subtypes were the predictor of the prognosis according to the 2015 WHO new classification of tumors of the lung, which can predict the prognosis of the patients and direct the individualized therapy in clinic.