Clinicopathologic factors influencing postoperative prognosis in patients with small-sized adenocarcinoma of the lung
Clinicopathologic factors influencing postoperative prognosis in patients with small-sized adenocarcinoma of the lung
复制标题
DOI：
10.1016/j.jtcvs.2007.10.034
复制
发表时间：
2008-04-01
影响因子：
6
通讯作者：
Okumura, Meinoshin
中科院分区：
文献类型：
--
作者：
Inoue, Masayoshi;Takakuwa, Tetsuya;Okumura, Meinoshin
目的：计算机断层扫描技术的最新发展增加了小肺癌手术治疗的发生率。虽然已经讨论了早期病变的叶下切除术的适应症，但我们偶尔也会遇到局部晚期的小肺癌伴淋巴结转移。本研究旨在阐明影响此类患者淋巴结转移和预后的组织病理学因素。方法：对97例直径小于或等于2 cm的腺癌患者行全切除手术。显微镜下观察淋巴结转移和坏死情况，免疫组织化学检测Ki-67和D2-40的增殖活性和淋巴侵袭情况。此外，还观察了癌胚抗原在肿瘤中的表达及血清中癌胚抗原的水平。结果：5年无瘤生存率为90%。肿瘤显微镜下坏死、Ki-67标记指数大于5%、血清癌胚抗原水平升高的患者，结节受累明显。此外，病变镜下坏死(68%)、Ki-67标记指数大于5%(76%)、D2-40染色发现有淋巴管侵犯(77%)的患者5年无瘤生存率较差。多因素分析表明，D2-40检测到的淋巴侵犯是术后复发的独立预测因素。结论：这些结果表明，显微镜下的坏死、Ki-67标记指数和血清癌胚抗原水平是淋巴结转移的预测因素。对于有显微镜下坏死、高Ki-67标记指数和淋巴侵犯的肿瘤患者，即使是IA期的患者，也需要仔细地进行术后复发的随访检查。
Objective: Recent technologic developments in computed tomography have increased the incidence of surgical intervention for small-sized lung cancer. Although indications of a sublobar resection for early disease have been discussed, we occasionally encounter locally advanced small-sized lung cancer with node metastasis. The present study aimed to clarify the histopathologic factors influencing nodal involvement and prognosis of such patients.Methods: We studied 97 patients who underwent complete resection for an adenocarcinoma of 2 cm or less in diameter. Lymph node metastasis and necrosis were microscopically evaluated, whereas immunohistochemical studies were also performed with Ki-67 and D2-40 for proliferation activity and lymphatic invasion, respectively. In addition, carcinoembryonic antigen expression in the tumor and its level in serum were investigated. Survival analysis was then conducted by using these clinicopathologic factors.Results: The 5-year disease-free survival rate was 90%. Nodal involvement was significantly frequent in patients with tumors showing microscopic necrosis, a Ki-67 labeling index of greater than 5%, and an increased serum carcinoembryonic antigen level. Furthermore, 5-year disease-free survival was worse in patients with lesions showing microscopic necrosis (68%), a Ki-67 labeling index of greater than 5% (76%), and lymphatic invasion detected with D2-40 staining (77%). Multivariate analysis identified lymphatic invasion detected with D2-40 to be an independent predictor for postoperative recurrence.Conclusions: These results indicate that microscopic necrosis, Ki-67 labeling index, and serum carcinoembryonic antigen level are predictors of nodal involvement. Careful postoperative follow-up examinations for recurrence are required for patients with tumors that show microscopic necrosis, high Ki-67 labeling index, and lymphatic invasion, even in those with stage IA disease.