亚厘米肺腺癌临床特征及预后分析

Clinical Characteristics and Prognosis of Sub-centimeter Lung Adenocarcinoma

背景与目的随着肺癌筛查的逐渐推广,越来越多的患者被确诊为亚厘米(直径≤1 cm)肺腺癌。亚厘米肺腺癌多为早期肺癌,但目前关于亚厘米肺腺癌的研究仍不充分。本研究针对亚厘米肺腺癌患者临床特征及预后进行分析,为该类患者的诊疗提供依据。方法回顾性分析2012年1月-2016年12月北京大学人民医院经胸腔镜手术病理确诊为亚厘米肺腺癌患者的临床及预后资料。根据结节影像学特征将患者分为纯磨玻璃结节(pure groundglass nodules, pGGN)、混杂性磨玻璃结节(mixed ground-glass nodules, mGGN)和实性结节(solid nodules, SN)组,对比三组患者临床特征并对不同直径结节行亚组分析。此外,通过多因素分析筛选亚厘米肺浸润性腺癌的独立危险因素。结果本组共182例患者,中位年龄54(27-75)岁。男性57例,女性125例。女性亚厘米肺腺癌患者无吸烟史比例显著高于男性(P<0.001)。所有1 mm-10 mm pGGN、1 mm-5 mm mGGN及1 mm-5 mm SN患者术后病理除原发灶外无其他阳性发现。46例6 mm-10 mm mGGN患者中有3例侵犯胸膜,1例发现脉管癌栓。39例6 mm-10 mm SN患者中有5例侵犯胸膜,2例发现脉管癌栓,2例出现淋巴结转移。侵犯胸膜、发现脉管癌栓或淋巴结转移的患者其病理类型均为浸润性腺癌。多因素Logistic回归分析发现吸烟史、既往肿瘤病史、mGGN、SN和肿瘤直径>5 mm是病理为肺浸润性腺癌的独立危险因素。中位随访时间44(22-82)个月,全组患者5年无复发生存率100.0%,总生存率98.9%。结论亚厘米肺腺癌患者发病年龄相对较小。影像学表现为6 mm-10 mm mGGN和6 mm-10 mm SN的亚厘米肺浸润性腺癌患者存在侵犯胸膜或淋巴结转移可能。吸烟史、既往肿瘤病史、m GGN、SN和肿瘤直径>5 mm为亚厘米肺浸润性腺癌的独立危险因素。对于亚厘米肺腺癌患者,早期发现并采取合适且有效的外科干预可获得良好的预后。

Background and objective With the increase of lung cancer screening, more and more patients have been diagnosed as sub-centimeter(≤1 cm) lung adenocarcinoma. Sub-centimeter lung adenocarcinoma is mostly early stage lung cancer, but the research on sub-centimeter lung adenocarcinoma is still insufficient. This study analyzed the clinical characteristics and prognosis of patients with sub-centimeter lung adenocarcinoma in order to provide the basis for the diagnosis and treatment of such patients. Methods A retrospective study was performed to analyze patients with sub-centimeter lung adenocarcinoma who underwent VATS in Peking University People’s Hospital from January 2012 to December 2016. Patients were divided into pure ground-glass nodules(pGGN) group, mixed ground-glass nodules(mGGN) group and solid nodules(SN) group according to the features of nodular imaging. The clinical characteristics of the three groups were compared and the subgroup analysis of nodules in different diameter was performed. We also performed multivariate logistic regression analyses to identify the risk factors for sub-centimeter lung invasive adenocarcinoma. Results The study included 182 patients(57 men and 125 women) with a median age of 54(27-75) years. Female sub-centimeter lung adenocarcinoma patients had a significantly lower proportion of non-smoking history than males(P<0.001). All patients with 1 mm-10 mm pGGN, 1 mm-5 mm mGGN and 1 mm-5 mm SN had no other pathologically positive findings except for the primary lesion. Of the 46 patients with 6 mm-10 mm mGGN, 3 had pleural invasion and 1 had vascular tumor thrombus. Of the 39 patients with 6 mm-10 mm SN, 5 had pleural invasion, 2 had vascular tumor thrombus and 2 had lymph node metastasis. The pathological type in each patient with pleural invasion, vascular tumor thrombus or lymph node metastasis was invasive adenocarcinoma. Logistic regression analysis indicated that smoking history(OR=4.727, P=0.009), previous tumor history(OR=3.408, P=0.015), mGGN(OR=3.735, P=0.004), SN(OR=8.921, P<0.001) and tumor diameter >5 mm(OR=4.241, P=0.001) were independent risk factors for sub-centimeter lung invasive adenocarcinoma. The median follow-up time was 44(22-82) months. The 5-year recurrence-free survival rate was 100.0% and the overall survival rate was 98.9%. Conclusion Patients with sub-centimeter lung adenocarcinoma have a relatively earlier onset age. Sub-centimeter lung invasive adenocarcinoma patients with 6 mm-10 mm m GGN and 6 mm-10 mm SN may be involved in pleural invasion or lymph node metastasis. Smoking history, previous tumor history, mGGN, SN and tumor diameter >5 mm are independent risk factors for sub-centimeter lung invasive adenocarcinoma. For patients with sub-centimeter lung adenocarcinoma, early detection and appropriate surgical intervention can lead to a good prognosis.