IASLC分级系统与Ⅰ期浸润性非黏液型肺腺癌患者预后关系的回顾性研究

张颖 耿华 李世雄 赵术彤 徐美林

张颖, 耿华, 李世雄, 赵术彤, 徐美林. IASLC分级系统与Ⅰ期浸润性非黏液型肺腺癌患者预后关系的回顾性研究[J]. 中国肿瘤临床, 2023, 50(9): 477-482. doi: 10.12354/j.issn.1000-8179.2023.20230017
引用本文: 张颖, 耿华, 李世雄, 赵术彤, 徐美林. IASLC分级系统与Ⅰ期浸润性非黏液型肺腺癌患者预后关系的回顾性研究[J]. 中国肿瘤临床, 2023, 50(9): 477-482. doi: 10.12354/j.issn.1000-8179.2023.20230017
Ying Zhang, Hua Geng, Shixiong Li, Shutong Zhao, Meilin Xu. A retrospective study on the relationship between IASLC grading system and prognosis in patients with stage I invasive non-mucinous lung adenocarcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(9): 477-482. doi: 10.12354/j.issn.1000-8179.2023.20230017
Citation: Ying Zhang, Hua Geng, Shixiong Li, Shutong Zhao, Meilin Xu. A retrospective study on the relationship between IASLC grading system and prognosis in patients with stage I invasive non-mucinous lung adenocarcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(9): 477-482. doi: 10.12354/j.issn.1000-8179.2023.20230017

IASLC分级系统与Ⅰ期浸润性非黏液型肺腺癌患者预后关系的回顾性研究

doi: 10.12354/j.issn.1000-8179.2023.20230017
基金项目: 本文课题受北京医学奖励基金会项目(编号:YXJT-2021-646-479)资助
详细信息
    作者简介:

    张颖:专业方向为肺腺癌的肿瘤微环境相关研究

    通讯作者:

    徐美林 meilinxugh2017@163.com

A retrospective study on the relationship between IASLC grading system and prognosis in patients with stage I invasive non-mucinous lung adenocarcinoma

Funds: This work was supported by Beijing Medical Award Foundation (No. YXJT-2021-646-479)
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  • 摘要:   目的  回顾性分析国际肺癌研究协会(IASLC)分级系统与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性及与患者预后的关系。  方法  回顾性分析2015年1月至2018年12月就诊于天津市胸科医院的204例Ⅰ期浸润性非黏液型肺腺癌患者的临床病理资料及随访资料,根据IASLC分级系统对患者分组,采用单因素方差分析、χ2检验和Fisher精确检验分析IASLC分级与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性,及与肺腺癌患者预后的关系。通过Kaplan-Meier法计算浸润性非黏液型肺腺癌患者总生存率(overall survival,OS)、无复发生存率(recurrence-free survival,RFS);采用Log-rank法比较不同组间的差异性。使用单因素Cox回归、多因素Cox回归分析独立危险因素。  结果  204例患者中IASLC分级为Ⅰ级108例,Ⅱ级66例,Ⅲ级30例。IASLC分级与性别(P=0.022)、吸烟史(P=0.041)、脉管侵犯(P=0.004)、胸膜累及(P=0.001)、病理分期(P<0.001)、肿瘤直径(P<0.001)均显著相关。单因素生存分析结果显示,胸膜累及(P=0.043)与IASLC分级(P<0.001)均对OS有显著影响;IASLC分级对RFS有显著影响(P<0.001)。多因素Cox回归分析显示肿瘤直径(P=0.005)与IASLC分级(P=0.002)是影响Ⅰ期肺腺癌患者OS的独立危险因素;肿瘤直径(P=0.007)、IASLC分级(P=0.003)是Ⅰ期肺腺癌患者RFS的独立危险因素。  结论  IASLC分级为Ⅰ期浸润性非黏液型肺腺癌预后的独立预后因素,IASLC分级越高Ⅰ期浸润性非黏液型肺腺癌患者预后越差。该分级系统提供了一个新的预后分组模式,为Ⅰ期浸润性非黏液型肺腺癌患者的术后管理及治疗提供新思路。

     

  • 图  1  IASLC不同分级的组织学亚型表现

    A: Ⅰ级:附壁为主型,高级别成分<20% ;B:Ⅱ级:乳头为主型,高级别成分<20% ;C:Ⅲ级:实性、微乳头成分≥20%

    图  2  Ⅰ期浸润性非黏液型肺腺癌患者术后的Kaplan-Meier生存曲线

    A:OS;B:RFS

    表  1  IASLC 分级与临床病理特征的关系

    项目IASLC分级 例(%)  P χ2
    性别0.0227.666
     男45(41.7)30(45.5)21(70)
     女63(58.3)36(54.5)9(30)
    吸烟史0.0416.368
     无72(66.7)45(68.2)13(43.3)
     有36(33.3)21(31.8)17(56.7)
    脉管侵犯0.00411.246
     无42(38.9)10(15.2)8(26.7)
     有66(61.1)56(84.8)22(73.3)
    胸膜累及0.00114.070
     无87(80.6)37(56.1)17(56.7)
     有21(19.4)29(43.9)13(43.3)
    病理分期(期)<0.00116.435
     ⅠA86(79.6)34(51.5)17(56.7)
     ⅠB22(20.4)32(48.5)13(43.3)
    部位0.430*7.948
     左肺上叶24(22.2)19(28.8)6(20.0)
     左肺下叶18(16.7)11(16.7)2(6.7)
     右肺上叶45(41.7)20(30.3)12(40.0)
     右肺中叶4(3.7)4(6.1)4(13.3)
     右肺下叶17(15.7)12(18.2)6(3.3)  
    *:采用Fisher精确检验
    下载: 导出CSV

    表  2  Ⅰ期肺腺癌术后的生存分析

    项目OSRFS
    平均时间(月)P平均时间(月)P
    性别0.3080.356
     男67.1159.18
     女73.3261.51
    吸烟史0.3190.960
     无73.2260.61
     有65.0760.49
    脉管侵犯0.9220.184
     无63.1960.70
     有72.8459.85
    胸膜累及0.0430.102
     无73.7360.33
     有64.0857.66
    病理分期(期)0.0680.766
     ⅠA73.7259.56
     ⅠB63.7659.29
    部位0.7820.996
     左肺上叶67.8561.03
     左肺下叶71.6959.25
     右肺上叶67.4960.15
     右肺中叶60.5457.02
     右肺下叶59.9556.24
    IASLC分级(级)<0.001<0.001
     Ⅰ75.3164.91
     Ⅱ65.3456.87
     Ⅲ59.85 50.06 
    OS:累积生存时间;DFS:无病生存时间
    下载: 导出CSV

    表  3  OS的单因素和多因素分析

    项目单因素分析多因素分析
    HR95%CIPHR95%CIP
    年龄1.0240.981~1.0680.284
    性别0.313
     男1.6450.626~4.322
     女1.000
    吸烟史0.324
     无1.000
     有1.6160.623~4.188
    肿瘤直径4.7441.643~13.6980.0042.4821.323~4.6560.005
    脉管侵犯0.922
     无1.000
     有0.9490.334~2.695
    胸膜累及0.051
     无1.000
     有2.5780.995~6.684
    病理分期(期)0.766
     ⅠA1.000
     ⅠB2.3670.913~6.137
    部位
     左肺上叶1.0000.803
     左肺下叶2.4330.406~14.5670.330
     右肺上叶2.3340.485~11.2480.291
     右肺中叶2.0860.189~23.0400.548
     右肺下叶2.9400.538~16.0590.213
    IALSC分级(级)
     Ⅰ1.0000.0011.0000.002
     Ⅱ3.4560.864~13.8210.0802.3660.584~9.5880.228
     Ⅲ11.7213.104~44.252<0.0018.8912.331~33.9070.001
    下载: 导出CSV

    表  4  RFS的单因素和多因素分析

    项目单因素分析多因素分析
    HR95%CIPHR95%CIP
    年龄1.0240.981~1.0680.284
    性别0.358
     男1.3380.719~2.491
     女1.000
    吸烟史0.960
     无1.000
     有1.0170.530~1.950
    肿瘤直径1.9221.319~2.8010.0011.7571.169~2.6410.007
    脉管侵犯0.189
     无1.000
     有1.6810.774~3.649
    胸膜累及0.106
     无1.000
     有1.6820.895~3.159
    病理分期(期)0.766
     ⅠA1.000
     ⅠB1.1040.575~2.118
    部位
     左肺上叶1.0000.996
     左肺下叶0.9620.342~2.7070.941
     右肺上叶1.0250.448~2.3440.953
     右肺中叶1.2200.330~4.5100.765
     右肺下叶1.1270.419-3.0280.813
    IALSC分级(级)
     Ⅰ1.0000.0011.0000.003
     Ⅱ3.2211.519~6.8300.0022.5091.163~5.4150.019
     Ⅲ4.6922.031~10.839<0.0014.1951.809~9.7280.001
    下载: 导出CSV
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  • 收稿日期:  2023-01-05
  • 录用日期:  2023-04-07
  • 修回日期:  2023-04-06

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