经气腔内播散与肺腺癌临床病理特征及预后关系的系统评价与Meta分析  

Relationship of spread through air spaces and specific clinicopathological features or poor prognosis of lung adenocarcinoma: A systemic review and meta-analysis

作　　者：宋毅杰 陈楠[1,2] 王子淮[1,2] 周健 杨振宇[1,2] 刘伦旭[1] SONG Yijie;CHEN Nan;WANG Zihuai;ZHOU Jian;YANG Zhenyu;LIU Lunxu(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;West China School of Medicine,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]四川大学华西临床医学院,成都610041

出　　处：《中国胸心血管外科临床杂志》2019年第7期625-632,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的鉴定与肺腺癌经气腔内播散(STAS)相关的临床病理特征并分析STAS对患者预后的影响。方法检索PubMed、EMbase和Web of Science数据库,纳入肺腺癌STAS与预后或临床病理特征关系的研究。检索时间为数据库建库至2019年3月。采用纽卡斯尔-渥太华量表(NOS)评价纳入研究的质量,评分6分以上为高质量研究。采用Stata12.0进行统计分析。结果共纳入20项研究,包含6225例患者。纳入文献整体质量较高,NOS评分均为6分及6分以上。STAS与男性、有吸烟史、异常癌胚抗原水平、支气管充气征阴性、间变性淋巴瘤激酶(ALK)重排、表皮生长因子受体(EGFR)突变阳性、病理较高分期、更高侵袭性腺癌亚型相关。STAS阳性与显著更差的无复发生存期(RFS)(HR=1.960,95%CI1.718~2.237,P<0.001)和总生存(OS)相关(HR=1.891,95%CI1.389~2.574,P<0.001)。亚组分析结果显示,腺癌直径<2cm(HR=2.344,95%CI1.703~3.225,P<0.001)以及直径>2cm(HR=2.571,95%CI1.559~4.238,P<0.001)、行肺叶切除(HR=1.636,95%CI1.258~2.127,P<0.001)以及行亚肺叶切除(HR=3.549,95%CI2.092~6.021,P<0.001)的Ⅰ期肺腺癌均显示STAS对RFS有不良影响。结论肺腺癌STAS阳性与更具侵袭性的临床病理特征相关,且STAS阳性与不良RFS和OS均相关。同时,在单独对Ⅰ期肺腺癌亚组分析后表明,无论Ⅰ期腺癌大小(直径<2cm或>2cm),还是Ⅰ期腺癌行亚肺叶切除或肺叶切除,均显示STAS对RFS有不良影响。Objective To assess the specific clinicopathological characteristics as well as prognostic value of prognostic significance of spread through air spaces (STAS) in lung adenocarcinoma. Methods We systematically searched the databases of PubMed, EMbase and Web of Science databases from their date of inception to March 2019. The quality of the included literature was assessed by the Newcastle-Ottawa scale (NOS). The NOS of the study higher than 6 points was considered as high quality. Software of Stata 12.0 was used for meta-analysis. Results Twenty retrospective cohort studies involved with totally 6 225 patients were included. Quality of included studies was high with NOS score equal or higher than 6 points. STAS was associated with male sex, ever smoking history, abnormal carcino-embryonic antigen (CEA) level, air bronchogram negative, anaplasticlymphoma kinase (ALK) arrangement positive, epidermal growth factor receptor (EGFR) mutation positive, advanced pathological tumor stage and more invasive pathological adenocarcinoma subtypes. The presence of STAS indicated significantly poor recurrence free survival (RFS)(HR=1.960, 95%CI 1.718-2.237, P<0.001) as well as poor overall survival (OS)(HR=1.891, 95%CI 1.389-2.574, P<0.001). Further subgroup analyses showed that exhibiting tumor size including diameter less than 2 cm (HR=2.344, 95%CI 1.703-3.225, P<0.001) and diameter over 2 cm (HR=2.571, 95%CI 1.559-4.238, P<0.001), resection type including lobectomy (HR=1.636, 95%CI 1.258-2.127, P<0.001) and sublobar resection (HR=3.549, 95%CI 2.092-6.021, P<0.001) in stageⅠ adenocarcinoma suggested that STAS had a bad effect on RFS. Conclusion Presence of STAS is associated with more aggressive clinicopathological features and independently associated with worse RFS and OS in lung adenocarcinoma. STAS positive has a negative effect on RFS whatever the tumor size (including the diameter<2 cm or >2 cm) and resection types in stageⅠ adenocarcinoma.

关 键 词：经气腔内播散 肺腺癌 预后 

分 类 号：R734.2[医药卫生—肿瘤]