Ⅰ期肺腺癌中病理学亚型判断预后的价值分析

Validation of prognostic value of pathological staging in pathological stageⅠlung adenocarcinoma

目的探讨2021年WHO肺腺癌分类判断Ⅰ期肺腺癌预后的价值。方法回顾性分析2015年1月至2016年9月于复旦大学附属中山医院接受手术,且术后病理学检查确诊为Ⅰ期肺腺癌的829例患者资料。男性389例,女性440例,年龄(60±11)岁(范围:32~90岁)。术前CT表现为实性结节570例,磨玻璃结节259例。采用Kaplan-Meier法绘制生存曲线,Log-rank进行组间比较,采用Cox比例风险模型分析影响总体生存和无复发生存的因素。结果829例患者中腺泡型为主型470例,乳头型为主型165例,贴壁型为主型90例,实体型为主型62例,微乳头型为主型42例。与实性结节组相比,磨玻璃结节组患者中贴壁型为主型比例更高[20.5%(53/259)比6.5%(37/570),χ^(2)=35.922,P<0.01],而微乳头型[1.2%(3/259)比6.8%(39/570),χ^(2)=11.961,P<0.01]和实体型[1.5%(4/259)比10.2%(58/570),χ^(2)=19.172,P<0.01]为主型比例更低。贴壁型为主型的患者预后最好,腺泡型和乳头型为主型较差,实体型和微乳头型为主型的预后最差(P值均<0.01)。T2期(HR=1.631,95%CI:1.030~2.583,P=0.037)、病理主型(P=0.036)、存在微乳头型成分(HR=1.764,95%CI:1.143~2.722,P=0.010)及CT表现为实性结节(HR=18.690,95%CI:7.587~46.043,P<0.01)为术后复发的预后因素。亚组分析结果显示,在实性结节和磨玻璃结节中,存在实体型成分均是总体生存的预后因素,存在微乳头型成分则均是无复发生存的预后因素。结论除病理学亚型外,存在微乳头型成分和实体型成分也是Ⅰ期肺腺癌患者的预后因素。病理学亚型与T分期相结合对Ⅰ期肺腺癌患者预后的判断更有价值、更可靠。

Objectives To examine the prognostic significance of WHO classification of lung adenocarcinoma in 2021 in patients with stageⅠpulmonary adenocarcinoma.Methods The clinical data of 829 patients who underwent surgery from January 2015 to September 2016 at Department of Thoracic Surgery,Zhongshan Hospital of Fudan University and had a postoperative pathologically confirmed diagnosis of stageⅠlung adenocarcinoma were analyzed retrospectively.There were 389 males and 440 females,aged(60±11)years(range:32 to 90 years),including 570 cases with solid nodules,259 cases with ground-glass nodule.The survival curve was plotted using the Kaplan-Meier method and compared by the Log-rank test.The Cox proportional hazards regression model was used to identify prognosis factors on overall survival(OS),and recurrence-free survival(RFS).Results Among the 829 patients,470 cases were acinar predominant type,165 cases were papillary predominant type,90 cases were lepidic predominant type,62 cases were solid predominant type,and 42 cases were micropapillary type.Compared with the solid nodule group,the proportion of patients with lepidic predominant type was higher in the ground glass nodule group(20.5%(53/259)vs.6.5%(37/570),χ^(2)=35.922,P<0.01),while the proportion of micropapillary(1.2%(3/259)vs.6.8%(39/570),χ^(2)=11.961,P<0.01)and solid predominant type(1.5%(4/259)vs.10.2%(58/570),χ^(2)=19.172,P<0.01)was lower.Survival analysis of 829 patients showed that patients with the lepidic predominant had the best prognosis,those with acinar and papillary predominant were worse,and patients with solid and micropapillary predominant had the worst prognosis(all P<0.01).The independent prognosis factors associated with postoperative recurrence were T2 stage(HR=1.631,95%CI:1.030 to 2.583,P=0.037),pathologic subtype(P=0.036),presence of a micropapillary component(HR=1.764,95%CI:1.143 to 2.722,P=0.010),and solid nodule in CT picture(HR=18.690,95%CI:7.587 to 46.043,P<0.01).Subgroup analysis showed that in both solid and ground-glass nodules,the presence of a solid-type component was a prognosis factor for overall survival,and the presence of a micropapillary component was a prognosis factor for recurrence-free survival.Conclusions The presence of micropapillary and solid component,in addition to histological subtype,are prognosis factors for patients with stageⅠlung adenocarcinoma.For patients with stageⅠlung adenocarcinoma,the combination of pathological subtype and T-stage is more valuable and reliable for prognosis.