伴微乳头结构肺腺癌患者预后及其影响因素分析

Analysis of prognosis of pulmonary adenocarcinoma with a micropapillary pattern and its influencing factors

目的分析伴微乳头结构肺腺癌(MPPAC)患者预后的影响因素。方法对2012年8月至2015年8月在山东省肿瘤医院行手术治疗的109例MPPAC患者进行回顾性分析。Kaplan-Meier法计算患者中位生存时间及l、3、5年生存率,单因素分析采用log-rank法,多因素分析采用Cox回归分析。结果109例MPPAC患者中位总生存时间为55.0个月(3~67个月),1、3、5年总生存率分别为89.0%、61.5%和48.6%。单因素分析结果显示,性别(χ^2=7.208,P=0.007)、肿瘤大小(χ^2=24.083,P<0.01)、淋巴结转移(χ^2=23.068,P<0.01)、脉管瘤栓(χ^2=16.411,P<0.01)、脏层胸膜浸润(χ^2=18.438,P<0.01)、多发肿瘤(χ^2=28.563,P<0.01)与MPPAC患者总生存有关。多因素分析结果显示,肿瘤大小(RR=1.629,95%CI1.145~2.317,P=0.007)、淋巴结转移(RR=1.680,95%CI1.161~2.430,P=0.006)、脉管瘤栓(RR=2.867,95%CI1.286~6.392,P=0.010)是影响MPPAC患者预后的独立因素。结论MPPAC患者预后较差,肿瘤大小、淋巴结转移、脉管瘤栓影响MPPAC患者的预后。

Objective To analyze the prognostic influencing factors of pulmonary adenocarcinoma with a micropapillary pattern (MPPAC). Methods A total of 109 MPPAC patients who received surgical operation in Shandong Cancer Hospital Affiliated to Shandong University from August 2012 to August 2015 were retrospectively analyzed. The median survival time and the survival rate of 1-, 3- and 5-year were calculated by using Kaplan-Meier method, log-rank test was used for single-factor analysis and Cox regression analysis was used for multiple-factor analysis. Results The median overall survival time of 109 MPPAC patients was 55.0 months (3-67 months). The overall survival rate of 1-, 3- and 5-year was 89.0%, 61.5%, 48.6%, respectively. Single factor analysis showed that the gender (χ^2 = 7.208, P = 0.007), the tumor size (χ^2 = 24.083, P < 0.01), lymph node metastasis (χ^2 = 23.068, P < 0.01), vascular tumor thrombosis (χ^2 = 16.411, P < 0.01), visceral pleural infiltration (χ^2 = 18.438, P < 0.01) and multiple tumors (χ^2 = 28.563, P < 0.01) were associated with the overall survival of MPPAC patients. Multiple factor analysis showed that the tumor size (RR = 1.629, 95% CI 1.145-2.317, P = 0.007), lymph node metastasis (RR = 1.680, 95% CI 1.161-2.430, P = 0.006) and vascular tumor thrombosis (RR = 2.867, 95% CI 1.286-6.392, P = 0.010) were the independent prognosis factors for MPPAC patients. Conclusion The MPPAC patients have a poor prognosis. The tumor size, lymph node metastasis and vascular tumor thrombosis could influence the prognosis of MPPAC patients.