脏层胸膜侵犯与直径3～5cm非小细胞肺癌预后的相关性分析

Prognostic Signii cance of Visceral Pleural Invasion in 3-5 cm Non-small Cell Lung Cancer

目的评估脏层胸膜侵犯(viceral pleural invasion,VPI)对直径3~5 cm的非小细胞肺癌(non-small cell lung cancer,NSCLC)预后的意义。方法回顾性分析2006年1月至2010年12月我院直径3~5 cm的NSCLC患者112例的临床资料,其中男72例、女40,年龄61(28~72)岁。术后病理为腺癌(adenocarcinoma,AC)62例,鳞癌(squamous cell carcinoma,SCC)44例,其他类型的NSCLC6例112例患者中有63例术后病理证实发生VPI为VPI组,其余49例患者无VPI发生,为NVPI组。所有患者均完成根治性肺叶切除+纵隔淋巴结清扫术。结果112例患者术后30 d内无手术相关死亡。VPI组63例患者有吸烟史的患者比例要明显高于NVPI组(53.9%vs.28.6%,P=0.007),VPI组的鳞癌患者所占的比例较高(81.0%),而NVPI组腺癌所占的比例较高(73.5%),两组差异有统计学意义(P=0.003)。全组平均随访时间52个月。随访终点共32例患者死亡,总生存率(overall survival,OS)为71.4%。VPI组和NVPI组平均随访时间分别为51个月和54个月,两组差异无统计学意义(P=0.441)。Kaplan-Meier曲线分析结果显示VPI与NVPI两组随访终点OS分别为61.9%和83.7%,差异有统计学意义(P=0.017)。Cox回归分析显示仅年龄<65岁(P=0.007),TNM分期(P=0.013)及VPI(P=0.035)是NSCLC预后的独立影响因素。结论直径3~5 cm的NSCLC患者发生VPI的预后较差,需要更为积极的术后治疗。

Objective To evaluate the prognostic significance of visceral pleural invasion in diameter 3-5 cm nonsmall cell lung cancer(NSCLC). Methods A total of 112 patients who underwent lobectomy and pathologically diagnosed with NSCLC(3-5 cm) were included in our hospital between January 2006 and December 2010.There were 72 males and 40 females at average age of 61(28-72) years. There were 62 patients diagnosed as adenocarcinoma and 44 as squamous cell lung cancer. Viceral pleural invasion(VPI) was identified in 63 patients as a VPI group. The other 49 patients without VPI were as a NVPI group. All patients were performed with lobectomy and mediastinal lymph node dissection. Results There was no perioperative mortality. More smokers were included in the VPI group when compared with the NVPI group(53.9% vs. 28.6%,P=0.007). More squamous cell cancers were included in the VPI group,while more adenocarcinoma were included in the NVPI group with a statistical difference(P=0.003). The average follow-up duration was 52 months. A total of 32 death occurred at the endpoint. The overall survival(OS) of all included patients was 71.4%. The average follow-up duration was 51 months in the VPI group and 54 months in the NVPI group(P=0.441). There was no statistical difference in OS between the VPI group and the NVPI group(61.7% vs. 83.7%,P=0.017). Cox regression showed age less than 65 years(P=0.007),TNM stage(P=0.013),and VPI(P=0.035) were significant prognostic factors for NSCLC. Conclusion We identified the presence of VPI as an independent poor prognostic factor in NSCLC patients with diameter at 3-5 cm.