pT_(1a-c)期肺腺癌气腔播散的影响因素及预后分析  

Risk factors and prognosis of spread through air space in pT_(1a-c) stage lung adenocarcinoma

作　　者：刘扬 杨光 刘会宁 LIU Yang;YANG Guang;LIU Huining(Department of Thotacic Surgery,Hebei General Hospital,Shijiazhuang,Hebei 050051,China;Department of Thoracic Surgery,First Hospital of Hebei Medical University,Shijiazhuang,Hebei 050030,China)

机构地区：[1]河北省人民医院胸外科,河北石家庄050051 [2]河北医科大学第一医院胸外科,河北石家庄050030

出　　处：《中华肿瘤防治杂志》2024年第16期1000-1005,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：河北省政府资助优秀人才项目(LS202210)。

摘　　要：目的探讨早期肺腺癌患者发生气腔播散(STAS)的临床病理特征及预后。方法回顾性收集2015-01-01-2017-12-21在河北医科大学第一医院胸外科接受肺切除术的554例肿瘤长径≤3 cm肺腺癌患者(pT_(1a-c))资料,其中男261例,女293例。年龄31~79岁,中位年龄61岁。采用Mann-Whitney U检验、χ^(2)检验和Fisher确切概率法及二元logistic回归分析法分析预后及影响STAS发生的关联因素。结果ⅠA期(pT_(1a-c)N0M0)肺腺癌患者307例,其中男137例(44.6%),女170例(55.4%),发生STAS 71例,阳性率为23.1%。在ⅠA期肺腺癌患者中,STAS与肿瘤实性成分比例(CTR,Z=-2.245,P=0.025)、脉管瘤栓(χ^(2)=46.512,P<0.001)、不同病理类型(χ^(2)=6.782,P=0.011)、存在微乳头成分(Z=-4.569,P<0.001)及病理亚型中附壁成分缺失(χ^(2)=4.237,P=0.040)有关联。在554例入组患者中,单因素分析结果显示,STAS与脉管瘤栓、胸膜侵犯、淋巴结转移、N分期有关联(均P<0.05)。多因素分析结果显示,脉管瘤栓(OR=0.513,95%CI:0.301~0.874,P=0.014)和胸膜浸润(OR=20.475,95%CI:9.727~43.099,P<0.001)是STAS出现的独立风险因素。生存分析结果显示,STAS阳性患者表现为更差的无复发生存期和总生存期,均P<0.05。结论STAS是早期肺腺癌的不良预后因素,且与更具侵袭性的临床病理特征如CTR、胸膜侵犯、脉管瘤栓、微乳头成分和淋巴结转移等有关。Objective To investigate the clinicopathological risk factors and prognosis of spread through air space(STAS)in early lung adenocarcinoma.Methods Retrospective collection of data from 554 patients with lung adenocarcinoma with a tumor diameter<3 cm pT_(1a-c) who underwent pulmonary resection at the Department of Thoracic Surgery,First Hospital of Hebei Medical University from January 2015 to December 21,2017.Among them,there were 261 males and 293 females,aged 31-79 years,with a median age of 61 years.Mann Whitney U test,x-test,Fisher exact probability method,and binary logistic regression analysis were used to analyze the prognosis and associated factors affecting the occurrence of STAS.Results Totally 307 patients with stage I A(pT_(1a-c) N,M)lung adenocarcinoma,including 137 males(44.6%)and 170 females(55.4%),developed STAS in 71 cases,with a positive rate of 23.1%.In stageⅠA lung adenocarcinoma patients,the ratio of STAS to tumor solid components(CTR,Z=-2.245,P=0.025),vascular tumor thrombus(χ^(2)=46.512,P<0.001),different pathological types(χ^(2)=6.782,P=0.011),presence of micropapillary components(Z=-4.569,P<0.001),and absence of adherent components in pathological subtypes(χ^(2)=4.237,P=0.040)were associated.Among all enrolled patients with T<3 cm(pT_(1a-c)),univariate analysis showed that STAS was associated with vascular thrombosis,pleural invasion,lymph node metastasis,and N-stage(all P<005).The results of multivariate analysis showed that vascular tumor thrombus(OR=0.513,95%CI:0.301-0.874,P=0.014)and pleural infiltration(OR=20.475,95%CI:9.727-43.099,P<0.001)were independent risk factors for the occurrence of STAS.The survival analysis results showed that STAS positive patients had poorer recurrence free survival and overall survival,both P<005.Conclusion STAS is a poor prognostic factor for early lung adenocarcinoma and is associated with more invasive clinical and pathological features such as CTR,pleural infiltration,vascular tumor thrombus,micropapillary components,and lymph node metastasis.

关 键 词：肺腺癌 气腔播散 预后 脉管瘤栓 

分 类 号：R734.2[医药卫生—肿瘤]