脉管瘤栓对ⅠA期肺腺癌患者术后无复发生存期的影响分析  

Influence of Vascular Invasion on Postoperative Recurrence-Free Survival in Patients with StageⅠA Lung Adenocarcinoma

作　　者：袁振龙 曾慧 张国超 任静宇 徐嘉溪 黄宇菲 任芳洲 李仁达 谭锋维 薛奇 YUAN Zhen-long;ZENG Hui;ZHANG Guo-chao;REN Jing-yu;XU Jia-xi;HUANG Yu-fei;REN Fang-zhou;LI Ren-da;TAN Feng-wei;XUE Qi(National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Immunology and National Key Laboratory of Medical Molecular Biology,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences(CAMS)and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院,北京100021 [2]中国医学科学院基础医学研究所/北京协和医学院基础学院免疫学系医学分子生物学国家重点实验室,北京100730

出　　处：《肿瘤学杂志》2023年第2期117-122,共6页Journal of Chinese Oncology

基　　金：国家重点研发计划(2021YFC2500900);中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-061)。

摘　　要：[目的]探讨脉管瘤栓对ⅠA期肺腺癌患者术后无复发生存期的影响。[方法]回顾性分析2014年1月至2017年6月中国医学科学院肿瘤医院收治的442例行手术治疗的ⅠA期肺腺癌患者的临床病理及随访资料。根据脉管瘤栓状态将患者分为两组,即无脉管瘤栓(367例)和有脉管瘤栓(75例)组;并根据UICC/AJCC第8版肺癌术后病理肿瘤大小T分期进行分层分析,其中pT_(1a)(pT≤1 cm,75例)、pT_(1b)(1 cm<pT≤2 cm,245例)、pT_(1c)(2 cm<pT≤3 cm,122例)和pT_(1b/c)(1 cm<pT≤3 cm,367例)。采用Cox单因素、多因素比例风险模型和Kaplan-Meier曲线分析脉管瘤栓对患者无复发生存期的影响。[结果]有脉管瘤栓组的复发率高于无脉管瘤栓组(25.3%vs 6.3%,P<0.001)。基于pT分层的单因素和多因素Cox回归分析结果显示,在pT_(1)、pT_(1b)、pT_(1c)和pT_(1b/c)分层中,有脉管瘤栓患者的复发风险比无脉管瘤栓患者分别高3.711倍、3.808倍、3.421倍和3.759倍(均P<0.05)。pT_(1)、pT_(1b)、pT_(1c)和pT_(1b/c)中有脉管瘤栓组与无脉管瘤栓组患者的无复发生存期差异均有统计学意义,平均无复发生存期分别为(73.0±3.5)个月vs(91.3±0.9)个月(P<0.001)、(67.4±4.0)个月vs(91.5±1.2)个月(P=0.026)、(69.7±4.7)个月vs(85.3±2.1)个月(P=0.001)和(72.8±3.6)个月vs(91.0±1.0)个月(P<0.001)。[结论]对于ⅠA期肺腺癌患者,有脉管瘤栓患者复发率更高,无复发生存期更差。[Objective]To investigate the influence of vascular invasion on postoperative recurrence-free survival in patients with stageⅠA lung adenocarcinoma.[Methods]The clinicopathological and follow-up data of 442 patients with stageⅠA lung adenocarcinoma who underwent surgery in Cancer Hospital,Chinese Academy of Medical Sciences from January 2014 to June 2017 were retrospectively analyzed.Patients were divided into vascular invasion(-)group(367 cases)and vascular invasion(+)group(75 cases).According to the UICC/AJCC 8th edition tumor size T-stage(pT),the lung adenocarcinoma was further stratified to pT_(1a)(pT≤1 cm,75 cases),pT_(1b)(1 cm<pT≤2 cm,245 cases),pT_(1c)(2 cm<pT≤3 cm,122 cases)and pT_(1b/c)(1 cm<pT≤3 cm,367 cases).Cox univariate and multivariate proportional hazards models and Kaplan-Meier curves were used to analyze the influence of vascular invasion on the recurrence-free survival of patients.[Results]The recurrence rate of the vascular invasion(+)group was significantly higher than that of the vascular invasion(-)group(25.3%vs 6.3%,P<0.001).The results of univariate and multivariate Cox regression analysis based on pT stratification showed that the recurrence risk of pT1,pT1b,pT1c and pT1b/c patients with vascular invasion(+)was 3.711,3.808,3.421 and 3.759 times higher than that of patients with vascular invasion(-)(P<0.05).In pT1,pT1b,pT1c,and pT1b/c patients the recurrence-free survival of vascular invasion(+)group was significantly short than that of the corresponding vascular invasion(-)group(73.0±3.5 months vs 91.3±0.9 months,P<0.001;67.4±4.0 months vs 91.5±1.2 months,P=0.026;69.7±4.7 months vs 85.3±2.1 months,P=0.001;72.8±3.6 months vs 91.0±1.0 months,P<0.001,respectively).[Conclusion]For stageⅠA lung adenocarcinoma,patients with vascular invasion(+)have a higher recurrence rate and poorer recurrence-free survival.

关 键 词：肺腺癌 ⅠA期 脉管瘤栓 无复发生存期 回顾性队列研究 

分 类 号：R734.2[医药卫生—肿瘤]