不同病理类型肺腺癌临床和影像特征及预后分析

Clinical and imaging characteristics of lung adenocarcinoma of different pathological types and analysis for prognosis

目的:探讨不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenocarcinoma in situ,AIS)、微浸润性腺癌(minimally invasive adenocarcinoma,MIA)及浸润性腺癌(invasive adenocarcinoma,IAC)的临床、影像、病理特征及预后相关的影响因素。方法:回顾性选取自2012年01月至2019年01月我院行手术治疗且病理确诊的肺腺癌患者503例,根据病理类型分为AAH、AIS、MIA、IAC四组,对比四组患者的临床、影像、病理特征,并采用单因素方差分析和多因素Cox比例风险回归模型分析四组患者预后危险因素的相关性。结果:AAH、AIS、MIA、IAC四组患者在性别比例方面,女性多于男性;在年龄分布方面,青年阶段(≤45岁)和中老年阶段(61~75岁)的差异有统计学意义(P<0.01,P<0.01)。不同病理类型肺腺癌患者在结节大小、结节性质及手术方式上差异有统计学意义(P<0.05)。单因素生存分析发现,不同结节性质肺腺癌患者在手术年龄、再次手术及死亡率方面差异有统计学意义(P<0.05)。多因素分析发现,结节最长直径[HR=7.166,95%CI(1.011,50.823)]、N分期[HR=10.689,95%CI(2.276,50.200)]是肺腺癌患者预后的独立影响因素(P<0.05)。结论:在AAH-AIS-MIA-IAC肿瘤演变过程中,结节最长直径、实性成分大小及N分期是肺腺癌患者预后的影响因素,肺腺癌国际新分类方法有助于肺腺癌患者预后评估。

Objective:To analyze the clinical,imaging,pathological features and prognostic influence factors of atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Methods:A total of 503 patients with lung adenocarcinoma in our hospital from January 2012 to January 2019 were enrolled as subjects.According to the pathological types,the patients were divided into AAH,AIS,MIA and IAC groups.The clinical,imaging,pathological features of the four groups were compared.The correlation of prognostic risk factors of lung adenocarcinoma(AAH,AIS,MIA,IAC)at different pathological types was analyzed by univariate analysis and multivariate Cox proportional hazard regression model.Results:There were more females in each group in term of gender ratio.In term of age distribution,the difference between the young(≤45 years old)and the elderly(61~75 years old)was statistically significant(P<0.01,P<0.01).Lung adenocarcinoma patients of different pathological types were significantly different in terms of tumor diameter,tumor characteristics and operation(P<0.05).Univariate survival analysis indicated that operative age,reoperation and mortality were statistically significant in different nodule properties of lung adenocarcinoma patients(P<0.05).Multivariate Cox proportional hazards regression model analysis indicated that the largest diameter[HR=7.166,95%CI(1.011,50.823)]and N stage[HR=10.689,95%CI(2.276,50.200)]of the tumor were independent influencing factors for the prognosis of lung adenocarcinoma patients(P<0.05).Conclusion:As the evolution of AAH-AIS-MIA-IAC,the longest diameter,the solid components and N stage of the tumor are independent factors influencing the prognosis of lung adenocarcinoma patients.The proposed international classification of lung adenocarcinoma is conducive for the prognosis assessment of patients with lung adenocarcinoma.