Ⅰ期≤20 mm微小结节肺腺癌患者术后长期生存分析

Analysis of long-term survival of resected stage Ⅰ lung adenocarcinoma with less then 20 mm micro-small pulmonary nodules

目的:回顾性分析手术切除的直径≤20 mm的Ⅰ期微小结节肺腺癌患者的5年生存率,以及5年生存率与患者临床特征、影像学特点和干预方法间的关系。方法:收集2007年6月—2015年5月就诊的404例有高分辨CT(high resolutionCT,HRCT)图像、直径≤20mm、手术切除肺微小结节的肺癌患者进行研究。其中311例为Ⅰ期肺腺癌,直径≤10 mm的微结节患者102例,直径为11～20mm的小结节患者209例。分析患者的5年生存率与影像特点、临床特征和治疗方法的关系。结果:微小结节肺腺癌患者的5年生存率为97.7%,微结节和小结节肺腺癌患者的5年生存率分别为99.0%和97.2%。女性微小结节肺腺癌患者的5年生存率明显高于男性(98.4%vs 96.4%,P=0.042),吸烟微小结节肺腺癌患者的5年生存率低于不吸烟患者(92.3%vs 98.5%,P=0.019)。肺腺癌病理亚型、手术范围、有无淋巴结清扫和是否胸腔镜手术与患者的5年生存率无明显关系(P值均> 0.05)。结论:直径≤20 mm的Ⅰ期微小结节肺腺癌患者预后良好,男性和吸烟可能增加了患者的死亡风险。

Objective： To retrospectively study the 5-year survival rate of stage I lung adenocarcinoma patients with resected micro- and small- sized pulmonary nodules, and its relationship with the clinical characteristics, imaging features and intervention methods. Methods： From Jun 2007 to May 2015, a total of 404 cases with pulmonary nodules in diameter ≤20 mm detected by high resolution computed tomography （HRCT） and received surgical resection were enrolled. Among them, 311 cases had stage I lung adenocarcinoma,102 cases had micro-sized （diameter ≤10 mm） pulmonary nodules, 209 cases had small- sized （11 - 20 ram） pulmonary nodules. The relationship of 5-year survival with the clinical characteristics, imaging features and intervention methods was analyzed. Results： The 5-year survival rate of adenocarcinoma patients was 97.7%, and which of patients with micro- and small-sized pulmonary nodules was 99.0% and 97.2%, respectively. The 5-year survival rate of female patients with micro- and small-sized pulmonary nodules was higher than that of male patients （98.4% vs 96.4%, P = 0.042）. The 5-year survival rate of smokers was lower than that of non-smokers （92.3% vs 98.5%, P = 0.019）. The pathological subtypes, surgical range, lymph node dissection, and thoracoscopic surgery were not associated with 5-year survival rate （all P 〉 0.05）. Conclusion： The stage I lung adenocarcinoma patients with micro- and small-sized （diameter 20 ram） pulmonary nodules have a good prognosis. For these patients, male and smoking may increase the risk of death.