直径<1 cm肺腺癌浸润进展影响因素及临床预后探讨

Influencing factors of infiltration progression and clinical prognosis of lung adenocarcinoma with diameter less than 1 cm

目的:探讨直径<1cm肺浸润性腺癌发生独立影响因素及临床预后。方法回顾性分析我院2013年1月-2018年3月收治直径<1cm肺腺癌患者共364例临床资料,根据胸部影像学特征分组,其中pGGN(A组)122例,mGGN(B组)136例,SN(C组)106例,比较三组基线临床特征和手术相关指标,分析结节直径亚组病理相关指标和分期差异,采用Logistic回归模型评价直径<1cm肺浸润性腺癌发生独立影响因素。结果①364例患者均胸腔镜手术治疗,其中楔形切除,切缘距病灶均<2cm。C组肺叶切除比例显著高于A组、B组(P<0.05);男性吸烟比例显著高于女性(P<0.05);②122例pGGN患者中1~5mm病灶术后病理均为原位/微浸润腺癌;A组6~10mm病灶Ia1期比例显著高于1~5mm病灶(P<0.05)。mGGN中6~10mm病灶共92例,包括胸膜侵犯6例,脉管癌栓2例;SN中6~10mm病灶共78例,包括胸膜侵犯10例,脉管癌栓4例,淋巴结转移4例。③单因素分析结果显示,AIS+MIA和IAC组吸烟史、既往癌症罹患史、病灶影像学特征及病灶直径比较,差异有统计学意义(P<0.05);多因素分析结果显示,吸烟史、既往癌症罹患史、mGGN、SN及病灶直径>5mm,均是直径<1cm肺浸润性腺癌独立危险因素(P<0.05)。④364例患者中肺叶切除术后住院期间因肺栓塞死亡1例,随访时间为20~81个月,中位随访时间为43.0个月;随访过程中Ia1期患者中1例在术后14个月因肺炎死亡;随访总生存率为99.72%(362/363)。结论直径<1cm肺浸润性腺癌患者中mGGN和SN如病灶直径达6~10mm,更易累及胸膜或淋巴结;吸烟史、既往癌症罹患史、mGGN、SN及病灶直径>5mm均与直径<1cm肺浸润性腺癌发生独立相关。

Objective To investigate the influencing factors of infiltration progression and clinical prognosis of lung adenocarcinoma with diameter less than 1 cm.Methods The clinical data of 364 patients with diameter less than 1 cm were retrospectively chosen from January 2013 to March 2018 in our hospital.The chest imaging characteristics included 122 cases of pGGN(the group A),136 cases of mGGN(the group B)and 106 cases of SN(the group C).The baseline clinical characteristics and operation related indexes of the 3 groups were compared and pathological related indexes and stage differences of nodule diameter subgroup were analyzed.Logistic regression model was used to evaluate the independent influencing factors of lung infiltrating adenocarcinoma with diameter less than 1 cm.Results①364 patients were treated by thoracoscopic surgery and the distance between wedge resection edge and the focus was less than 2cm.The proportion of lobectomy in the group C were significantly higher than the group A and the group B(P<0.05).The smoking proportion of men were significantly higher than women(P<0.05).②122 patients with pGGN for 1-5mm lesions were all in situ/microinvasive adenocarcinoma.The proportion of IA1 stage in the group A with 6~10 mm lesions were significantly higher than 1~5 mm lesions(P<0.05).There were 92 cases for 6-10 mm lesions in mGGN,including 6 cases of pleural invasion and 2 cases of vascular thrombus.There were 78 cases for 6-10 mm lesions in SN,including 10 cases of pleural invasion,4 cases of vascular thrombus,and 4 cases of lymph node metastasis.③The results of univariate analysis showed that there were significant differences in smoking history,previous cancer history,imaging features and lesion diameter between AIS+MIA and IAC(P<0.05).Multivariate analysis showed that smoking history,previous cancer history,mGGN,Sn and lesion diameter>5mm were independent risk factors for lung infiltrating adenocarcinoma with diameter<1cm(P<0.05).④1 case was dead of pulmonary embolism during hospitalization after lobectomy,with follow-up time for 20-81 months and median follow-up time for 43.0 months.1 case was dead of pneumonia 14 months after operation during the follow-up time,with total survival rate for 99.72%(362/363).Conclusion The patients with mGGN and SN in lung adenocarcinoma with diameter less than 1 cm are more likely to be involved in pleura or lymph nodes if the lesion diameter is 6-10 mm.Smoking history,previous cancer history,mGGN,SN and lesion diameter>5mm are all independently related to the occurrence of lung infiltrating adenocarcinoma with diameter<1cm.