Ⅰ期非小细胞肺癌患者合并肺纤维化和肺气肿预测术后复发

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非小细胞肺癌癌症肿瘤肺纤维化肺气肿
Combined pulmonary fibrosis and emphysema predicts recurrence following surgery in patients with stage I non-small cell lung cancer

The purpose of this study was to clarify the clinicopathologic characteristics of non-small cell lung cancer (NSCLC) patients with combined pulmonary fibrosis and emphysema (CPFE). We investigated the association between CPFE, the cancer survival, and the pathological features of clinical stage I NSCLC patients. Between 2005 and 2014, 218 consecutive patients with clinical stage I NSCLC underwent complete resection with systematic lymph node dissection. A univariate analysis by log-rank tests was performed to determine the risk factors for recurrence, and the Cox proportional hazards regression model was used to identify potential independent predictors. The 5-year recurrence-free proportion of patients with CPFE was 36%, which was significantly lower than in those without CPFE (82%; p < 0.001). On multivariate analysis, the presence of CPFE was one of the statistically significant independent predictors for tumor recurrence (p = 0.005). Postoperative pathological prognostic factors, including moderate or poor histological differentiation, lymphatic permeation, intratumoral vascular invasion, and lymph node metastasis, were detected more often in patients with CPFE. NSCLC patients with CPFE have histologically more invasive tumors than those without CPFE. In patients with clinical stage I NSCLC, the presence of CPFE was a statistically significant predictor of recurrence.
本研究的目的是阐明合并肺纤维化和肺气肿（CPFE）非小细胞肺癌（NSCLC）患者的临床病理特征。我们研究了CPFE与癌症生存之间的关系以及临床Ⅰ期NSCLC患者的病理学特征。2005年至2014年期间，连续收治的218例临床I期NSCLC患者接受完全切除和系统淋巴结清扫术。通过log-rank检验进行单变量分析以确定复发的危险因素，使用Cox比例风险回归模型来识别潜在的独立预测因子。合并CPFE的患者5年无复发率为36％，明显低于无CPFE者（82％；P<0.001）。多因素分析显示，CPFE的存在是统计学上有显著意义的肿瘤复发独立预测因子之一（p = 0.005）。术后病理学预后因素，包括组织学中或低分化、淋巴弥散、瘤内血管侵犯和淋巴结转移，在CPFE患者中更常检出。具有CPFE的NSCLC患者比没有CPFE者肿瘤组织学更具侵袭性。在临床Ⅰ期的NSCLC患者中，CPFE的存在是一个有显著统计学意义的复发预测因子。