贴壁为主型Ⅰ期肺腺癌1371例多因素生存分析

Multivariate survival analysis of 1371 patients of lepidic predominant adenocarcinoma with stageⅠlung cancer

目的探讨以贴壁为主型Ⅰ期肺腺癌的预后影响因素,并比较不同手术方式对总生存期的影响。方法选取美国国立癌症研究所建立的SEER数据库中2004年1月至2015年1月的1371例有完整随访资料的贴壁为主型Ⅰ期肺腺癌患者的临床资料,根据是否接受手术及手术方式的不同分为未手术组(148例)、亚肺叶切除组(302例)和肺叶切除组(921例),采用卡方检验比较不同组间临床特征的差异,采用Cox比例风险模型进行多因素生存分析,Kaplan-Meier生存曲线比较不同治疗方式对患者生存期的影响。结果1371例患者中1223例(89.2%)接受了手术治疗,148例(10.8%)因心肺功能及合并其他慢性疾病等原因无法耐受手术;未接受手术治疗的患者中,117例(79.1%)患者年龄≥70岁,远高于接受手术治疗者(51.5%)。Cox多因素分析显示,年龄≥70岁、男性、肿瘤位于下叶、分化程度差、肿瘤分期高、未接受手术治疗者预后较差。Kaplan-Meier生存曲线分析显示,接受手术治疗者的总生存期明显高于未手术组,且肺叶切除术组明显高于亚肺叶切除术组,差异均有显著性(P<0.001)。结论在以贴壁为主型的Ⅰ期肺腺癌患者中,年龄≥70岁、男性、肿瘤位于下叶、分化程度差、肿瘤分期高、未接受手术治疗者预后相对较差,接受肺叶切除术的患者的总生存期高于接受亚肺叶切除术者。

Objective We aimed to investigate the prognostic factors of lepidic predominant adenocarcinoma in patients with stageⅠlung cancer and compare the effects of different surgical methods on overall survival.Method The clinical data of 1371 patients of lepidic predominant adenocarcinoma with stageⅠlung cancer were randomly selected from the Surveillance,Epidemiology,and End Results database(SEER)established by the National Cancer Institute of the United States from January 2004 to January 2015 and complete follow-up data were collected.The patients were divided into non-operation group(148 cases),sublobectomy group(302 cases)and lobectomy group(921 cases)according to the different operation methods.The analysis of differences in clinical characteristics between the different groups was performed using the chi-square test.Cox regression was performed to select the predictors of overall survival.Kaplan-Meier curves were used to illustrate and compare the overall survival of patients in different treatment.Result In this group,1223 patients(89.2%)received surgical treatment,and 148 patients(10.8%)could not tolerate surgery due to cardiopulmonary function and other chronic diseases.117 patients(79.1%)were diagnosed at the age of≥70 years in the group that did not receive surgery and the percentage of the patients who were over 70 was lower in the surgery group.Cox multivariate analysis showed that age≥70 years,male,tumor in lower lobe,poor differentiation,high tumor stage,and without surgical treatment had a poor prognosis.Kaplan-meier survival curve analysis showed that the overall survival of patients undergoing surgery was significantly higher than that of patients without surgery,and the lobectomy group was significantly higher than that of sublobectomy group(P<0.001).Conclusion Patients aged≥70 years,male,with tumors in the lower lobe,poorly differentiated,high tumor stage,and without surgical treatment had a relatively poor prognosis for lepidic predominant adenocarcinoma in patients with stageⅠlung cancer.The survival rate of patients in lobectomy group was higher than that in sublobectomy group.