气腔播散对不同肿瘤大小的pT1N0M0期肺腺癌患者术后无复发生存期的影响分析

Analysis of the effect of spread through air spaces on postoperative recurrence-free survival in patients with stage pT1N0M0 lung adenocarcinoma of different tumor size

目的探讨气腔播散(STAS)对不同肿瘤大小的pT1N0M0期肺腺癌患者术后无复发生存期(RFS)的影响。方法回顾性分析2014年1月至2018年6月中国医学科学院肿瘤医院胸外科511例行手术治疗的pT1N0M0肺腺癌患者的临床病理及随访资料, 男285例, 女226例, 年龄[M(Q1, Q3)]60(53, 66)岁。根据STAS状态将患者分为两组, 即STAS(-)组(342例)和STAS(+)组(169例);并根据美国癌症联合会(AJCC)第八版肺癌术后病理肿瘤大小T分期(pT)进行分层分析, 其中分为pT1a(pT≤ 1 cm, 93例)、pT1b(1 cm0.05)。IPTW调整前后, pT1b/c中STAS(+)组与STAS(-)组患者的RFS差异均有统计学意义[(72.50±2.23)比(85.12±0.72)个月, (77.74±1.12)比(84.59±0.64)个月, 均P<0.001]。此外, STAS(+)组与STAS(-)组相比, 局部和远处复发率更高(分别为6.7%比1.2%和8.2%比3.6%, 均P<0.05)。结论对于pT1bN0M0和pT1cN0M0的肺腺癌患者, STAS(+)患者局部和远处复发率更高, RFS更差。

Objective To investigate the effect of spread through air spaces(STAS)on the postoperative prognosis of patients with stage pT1N0M0 lung adenocarcinoma according to different tumor sizes.Methods The clinicopathological and follow-up data of 511 patients with pT1N0M0 lung adenocarcinoma treated surgically in the Department of Thoracic Surgery,Cancer Hospital,Chinese Academy of Medical Sciences from January 2014 to June 2018 were retrospectively analyzed.There were 285 males and 226 females,aged 60(53,66)years.Those patients were divided into two groups according to STAS status,including STAS(-)group(342 cases)and STAS(+)group(169 cases).And the stratified analysis was performed according to the American Cancer Consortium(AJCC)8th edition postoperative pathological tumor size T-stage(pT)of lung cancer,which was divided into pT1a(pT≤1 cm,93 cases),pT1b(1 cm<pT≤2 cm,280 cases),pT1c group(2 cm<pT≤3 cm,138 cases)and pT1b/c(1 cm<pT≤3 cm,418 cases).Univariate and multivariate Cox regression analyses and inverse probability weighted(IPTW)adjusted Kaplan-Meier(K-M)curves were used to analyze the effect of STAS on recurrence-free survival(RFS)in patients included in this study.Results The recurrence rate was significantly higher in the STAS(+)group compared to the STAS(-)group(22.5%vs 3.2%,P<0.001).Multifactorial Cox regression analysis based on pT stratification showed that the risks of recurrence were 4.56-fold(95%CI:1.56-13.33;P=0.006)and 3.16-fold(95%CI:1.07-9.33;P=0.038)higher in pT1b and pT1c staged patients with STAS(+)than in STAS(-)patients,respectively.There was no significant difference in RFS between the STAS(-)group of pT1b/c,pT1b and pT1c and all pT1a patients[(84.97±0.72)vs(84.05±1.11)months,(85.60±0.74)vs(84.05±1.11)months,(81.49±1.63)vs(84.05±1.11)months;all P>0.05].Before and after IPTW adjustment,statistically significant differences were found in RFS between STAS(+)group and STAS(-)group[(72.50±2.23)vs(85.12±0.72)months,(77.74±1.12)vs(84.59±0.64)months,all P<0.001].In addition,the risks of both local and distant recurrence were higher in STAS(+)group compared to STAS(-)group(6.7%vs 1.2%and 8.2%vs 3.6%,respectively;both P<0.05).Conclusion For lung adenocarcinoma patients with pT1bN0M0 and pT1cN0M0,those patients with STAS(+)had a higher incidence of both local and distant recurrence and with poor RFS.