内脏胸膜侵犯并不预示着肺癌患者和较小肿瘤大小的生存情况。
Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size.
机构信息
Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.
出版信息
Ann Thorac Surg. 2013 Jun;95(6):1872-7; discussion 1877. doi: 10.1016/j.athoracsur.2013.03.085. Epub 2013 May 2.
BACKGROUND
Visceral pleural invasion (VPI) is used as an indicator of adverse prognosis in non-small cell lung cancer (NSCLC). The purpose of this retrospective study was to evaluate the impact of VPI on disease-free survival (DFS) and overall survival (OS) in patients with node-negative NSCLC.
METHODS
Between 1998 and 2009, 1,166 patients with pathologic N0M0 NSCLC underwent surgical resection by lobectomy. Two hundred fourteen patients with VPI were compared with 952 patients without VPI.
RESULTS
Median follow-up was 59 months. In multivariate analysis, VPI, larger tumor size, older age, female sex, and poor performance status were significantly associated with decreased OS. In contrast, larger tumor size, female sex, and poor performance, but notably not VPI, were associated with decreased DFS. After examining interactive effects of VPI and T stage subgroups, we found that VPI did not significantly affect either OS or DFS in the subgroups of patients with smaller tumor sizes-stage T1a, stage T1b, or stage T2a. In contrast, a deleterious effect of VPI on DFS was seen for tumors larger than 5 cm-stages T2b and T3-with the VPI-stage T3 interaction effect being statistically significant for DFS but not for OS.
CONCLUSIONS
The effect of VPI on survival in NSCLC varies greatly with tumor size, with VPI not strongly associated with OS or DFS in tumors smaller than 5 cm, but showing large negative effects on DFS for stage T2b and stage T3 tumors. Using VPI to upstage T1 tumors to a higher T stage is not warranted because it would misrepresent these VPI-T stage subgroup effects.
背景
内脏胸膜侵犯（VPI）被用作非小细胞肺癌（NSCLC）不良预后的指标。本回顾性研究的目的是评估 VPI 对淋巴结阴性 NSCLC 患者无病生存（DFS）和总生存（OS）的影响。
方法
1998 年至 2009 年，1166 例病理 N0M0 NSCLC 患者接受肺叶切除术。214 例 VPI 患者与 952 例无 VPI 患者进行比较。
结果
中位随访时间为 59 个月。多变量分析显示，VPI、肿瘤较大、年龄较大、女性和较差的表现状态与 OS 降低显著相关。相反，较大的肿瘤大小、女性和较差的表现状态，但并非 VPI，与 DFS 降低相关。在检查 VPI 和 T 分期亚组的相互作用效应后，我们发现 VPI 对较小肿瘤大小亚组（T1a 期、T1b 期或 T2a 期）的患者的 OS 或 DFS 没有显著影响。相比之下，VPI 对大于 5cm 的肿瘤（T2b 和 T3 期）的 DFS 有不良影响，VPI-T3 期的相互作用效应在统计学上对 DFS 有影响，但对 OS 没有影响。
结论
VPI 对 NSCLC 生存的影响差异很大，与肿瘤大小相关，肿瘤小于 5cm 时，VPI 与 OS 或 DFS 无明显相关性，但 T2b 期和 T3 期肿瘤的 DFS 呈明显负相关。将 T1 期肿瘤升级为更高的 T 期以使用 VPI 来分期是没有必要的，因为这将歪曲这些 VPI-T 分期亚组的影响。
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