手术和辅助化疗对I期肺腺癌伴肺泡间转移患者生存率的影响

SCI  5 February 2023

Impact of surgery and adjuvant chemotherapy on the survival of stage I lung adenocarcinoma patients with tumor spread through air spaces

（Lung Cancer；IF: 6.081）

Yilv Lv, Siwen Li, Zhichao Liu, Zhanliang Ren, Jikai Zhao, Guangyu Tao, Zhichun Zheng, Yuchen Han, Bo Ye 

CORRESPONDENCE TO: yebo0430@sjtu.edu.cn 

Objectives 目的  

Tumor spread through air spaces (STAS) is a unique mechanism of lung cancer metastasis; however, its clinical value for stage I lung adenocarcinoma (ADC) remains unclear at present. We investigated the (1) prognosis of patients after sublobar resection compared with lobectomy for stage I lung adenocarcinoma with STAS; and (2) potential benefits of adjuvant chemotherapy (ACT) for patients with stage I ADC and STAS.

肺泡间转移(STAS)是肺癌转移的一种独特机制，其对I期肺腺癌(ADC)的临床价值仍尚未研究。本文研究了肺段切除和肺叶切除的I期肺腺癌伴肺泡间转移的患者预后，以及辅助化疗对I期肺腺癌伴肺泡间转移的患者的潜在益处。

Methods 方法  

A total of 3328 consecutive patients with stage I ADC were retrospectively identified between 2014 and 2018 at our institution; among them, 600 were diagnosed with STAS. Kaplan– Meier analysis and Cox proportional hazard regression models were used to evaluate the impact of STAS on overall survival (OS) and recurrence-free survival (RFS).

2014年至2018年期间，回顾性分析了3328例I期肺腺癌，其中600例伴肺泡间转移，Kaplan–Meier分析和Cox比例风险回归模型用于评估肺泡间转移对总生存率（OS）和无复发生存率（RFS）的影响。

Results 结果

Among stage IA patients with STAS, there was no significant difference between those who underwent sublobar resection and lobectomy in OS (P=0.919) and RFS (P=0.066). Multivariate analysis confirmed this result (sublobar resection versus lobectomy, OS: HR=0.523, 95% CI, 0.056-18.458, P=0.714; RFS, HR=0.360, 95% CI, 0.115-1.565, P=0.897). ACT did not improve the prognosis of stage IA patients but did improve the RFS of stage IB patients with high-risk recurrence factors, including poorly differentiated tumors, lymphovascular invasion and visceral pleural invasion (P=0.046).

在IA期STAS患者中，接受肺段切除和肺叶切除的患者在OS（P=0.919）和RFS（P=0.066）方面没有显著差异。多变量分析证实了这一结果（肺段切除与肺叶切除，OS:HR=0.523，95%CI，0.056-18.458，P=0.714；RFS，HR=0.360，95%CI 0.115-1.565，P=0.897）。辅助化疗没有改善IA期患者的预后，但改善了IB期具有高危复发因素的患者的RFS，包括低分化肿瘤、淋巴血管侵犯和内脏胸膜侵犯（P=0.046）。

Conclusions 结论   

Sublobar and lobectomy resection provided a comparable prognosis for stage IA ADC patients with STAS. When STAS was confirmed postoperatively, ACT should be considered for patients with stage IB with high-risk recurrence factors but not for those with stage IA disease. 

肺段切除和肺叶切除术为IA期ADC伴STAS患者提供了相当的预后。当术后证实STAS时，对于IB期有高危复发因素的患者应考虑辅助化疗，但对于IA期疾病的患者则不考虑辅助化疗。

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