微乳头状实体组织学亚型对I期肺腺癌行根治性切除术患者预后影响

Prognostic impact of micropapillary and solid histological subtype on patients undergoing curative resection for stage I lung adenocarcinoma according to the extent of pulmonary resection and lymph node assessment 

(Lung Cancer ;IF:5.705)

 背景

We aimed to evaluate the impact of micropapillary and/or solid (MPSOL) components on survival and recurrence of patients with resected stage I lung adenocarcinoma (LUAD) according to the extent of surgery and completeness of lymph node assessment (LNA).

我们的目的是根据手术范围和淋巴结评估完整性(LNA)，评估微乳头状和/或固体(MPSOL)成分对切除的I期肺腺癌(LUAD)患者生存和复发的影响。

Methods 方法

We retrospectively reviewed 1886 consecutive patients who underwent surgical resection for pathologic stage I LUAD between 2009 and 2014. The patients were classified by the presence (≥1%) of MPSOL into the MPSOL(+) (n = 489) and MPSOL(−) (n = 1397) group. We analyzed the outcomes according to the extent of surgery (sublobar resection [SR] vs. lobectomy) and the LNA (complete vs. incomplete). Complete LNA was defined as systematic LN dissection according to European Society of Thoracic Surgeons guideline.

我们回顾性分析了2009年至2014年期间连续1886例病理I期肺腺癌进行手术切除的患者。根据MPSOL的存在(≥1%)将患者分为MPSOL(+) (n = 489)和MPSOL(−)(n = 1397)组。我们根据手术范围(亚肺叶切除【SR】vs.肺叶切除)和LNA(完整vs.不完整)分析结果。根据欧洲胸外科学会指南，完全LNA定义为系统性淋巴结清扫。

Results 结果

 In the MPSOL(+) patients, there was no significant difference in adjusted overall survival (OS), recurrence-free survival (RFS), and recurrence pattern between the lobectomy and SR group. Of note, patients with complete LNA had higher adjusted OS and RFS than those with incomplete LNA (aOS, 86.3% vs. 78%, p = 0.002; aRFS, 70% vs 63.1%, p = 0.06). In the MPSOL(−) patients, adjusted RFS of the SR group was better than the lobectomy group (95% vs. 90.5%, p = 0.021), although there was no difference in survival regarding to the LNA. Complete LNA was a favorable prognostic factor for RFS in the MPSOL(+) patients (HR = 0.463, 95% CI: 0.227-0.944, p = 0.034).

在MPSOL(+)患者中，肺叶切除术组和亚肺叶切除组在校准后总生存期(OS)、无复发生存期(RFS)和复发模式方面无显著差异。值得注意的是，完全LNA患者的调整后OS和RFS高于不完全LNA患者(aOS, 86.3% vs. 78%， p = 0.002;aRFS, 70% vs 63.1%， p = 0.06)。在MPSOL(−)患者中，SR组校正后的RFS优于肺叶切除术组(95% vs. 90.5%， p = 0.021)，尽管LNA在生存率方面没有差异。完全LNA是MPSOL(+)患者RFS的一个有利预后因素(HR = 0.463, 95% CI: 0.227-0.944, p = 0.034)。

Conclusion 结论

In MPSOL(+) patients, complete LN assessment affects the OS and RFS rather than the extent of lung resection. In patients with solid tumor or tumor larger than 2cm, a complete LN assessment would be required, even if sublobar resection is unavoidable.

在MPSOL(+)患者中，完全LN评估影响OS和RFS，而不是肺切除的范围。对于实体瘤或肿瘤大于2cm的患者，即使是不可避免的亚肺叶切除，也需要完整的LN评估。

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