单发病灶Ⅰ和Ⅱ期非小细胞肺癌淋巴结转移及预后不良危险因素分析

Risk factors for lymph node metastasis and poor prognosis in stageⅠandⅡnon-small cell lung cancer with single lesion

目的探讨单发病灶的Ⅰ、Ⅱ期非小细胞肺癌(NSCLC)患者淋巴结转移及术后总生存期的危险因素。方法选取2015-01-01-2020-12-30在解放军第九六〇医院接受外科手术治疗且病理分期为Ⅰ、Ⅱ期的381例NSCLC患者为研究对象。回顾性分析患者的临床病理特征并对其随访,主要观察指标为淋巴结转移和总生存期。采用χ2检验、Cox比例风险模型、Kaplan-Meier以及logistic回归分析影响患者淋巴结转移及总生存期的危险因素。结果381例患者中,淋巴结转移66例,中位随访时间为39个月(10~85个月)。多因素二元logistic回归结果显示,性别(OR=2.098,95%CI为1.073~4.103,P=0.030)和术前癌胚抗原(CEA)≥3.47μg/L(OR=3.024,95%CI为1.713~5.339,P<0.001)为发生淋巴结转移的独立危险因素;多因素Cox比例风险模型分析结果显示,年龄>60岁(HR=3.165,95%CI为1.827~5.483,P<0.001)、肿瘤最大径≥2.25 cm(HR=2.081,95%CI为1.209~3.581,P=0.008)、有脏层胸膜浸润(HR=3.193,95%CI为1.941~5.253,P<0.001)与患者较差的术后总生存期相关。结论临床上,对于存在危险因素的患者更应注重纵隔淋巴结的清除以及术后的相关辅助治疗。

Objective To investigate the risk factors of lymph node metastasis(LNM)and overall survival(OS)in patients with stageⅠ/Ⅱnon-small cell lung cancer(NSCLC)with single lesion.Methods Clinical data of 381 patients with stageⅠorⅡNSCLC who underwent surgical treatment in the 960th Hospital of PLA from January 1,2015 to December 30,2020 were retrospectively analyzed and followed up.The primary outcome measures were lymph node metastasis and overall survival.Chi-square test,Cox proportional hazards model,Kaplan-Meier and logistic regression were used to analyze the clinicopathological features affecting lymph node metastasis and prognosis of patients.Results Of the 381 patients,66 had lymph node metastasis,and the median follow-up time was 39 months(10-85 months).Multivariate binary Logistic regression analysis showed that gender(OR=2.098,95%CI:1.073-4.103,P=0.030)and preoperative CEA≥3.47μg/L(OR=3.024,95%CI:1.713-5.339,P<0.001)were independent risk factors for lymph node metastasis.The results of multivariate Cox proportional hazards model showed that age>60 years(HR=3.165,95%CI:1.827-5.483,P<0.001),the maximum diameter of tumor≥2.25 cm(HR=2.081,95%CI:1.209-3.581,P=0.008)and visceral pleural invasion(HR=3.193,95%CI:1.941-5.253,P<0.001)were associated with poor overall survival.Conclusions In clinical practice,more attention should be paid to mediastinal lymph node dissection and postoperative adjuvant therapy for patients with risk factors.