Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung
Histological determinants of survival in completely resected T1-2N1M0 nonsmall cell cancer of the lung
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DOI：
10.1016/j.athoracsur.2003.08.080
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发表时间：
2004-04-01
影响因子：
4.6
通讯作者：
Duffy, JP
中科院分区：
文献类型：
--
作者：
Khan, OA;Fitzgerald, JJ;Duffy, JP
在幕后。手术切除II期非小细胞肺癌后的组织学决定因素还知之甚少。我们分析了肺T1-2N1M0非小细胞癌完全切除后一些组织学特征对预后的意义。我们回顾了1991-1997年间所有接受T1-2N1M0非小细胞肺癌根治性手术切除的患者的病历和组织学。记录了以下组织学因素：肿瘤的组织学类型；有转移沉积的结节数目及其结节位置；是否有血管侵犯、内脏胸膜受累和细胞坏死；以及肿瘤的分级。对98例患者的检查结果进行分析。采用单因素和多因素分析确定影响预后的因素。单因素分析显示，只有三个因素与预后不良有统计学意义的相关性：血管侵犯(P=0.002)、非鳞状组织学(P=0.005)和内脏胸膜侵犯(P=0.002)。多因素分析显示，三个因素均为显著的独立不良预后指标。内脏胸膜受累、非鳞状组织学和血管侵犯都是T1-2N1M0非小细胞肺癌手术切除后重要的不良预后因素。这些发现与以前发表的报告相冲突，我们主张进行前瞻性的大规模研究，以阐明II期疾病的组织学特征对预后的意义。
Back-ground. The histologic determinants of survival after surgical resection of stage II nonsmall cell lung cancer are poorly understood. We analyzed the prognostic significance of a number of histologic features after complete resection of T1-2N1M0 nonsmall cell cancer of the lung.Methods. The case notes and histology of all patients who underwent a potentially curative surgical resection for T1-2N1M0 nonsmall cell carcinoma of the lung between 1991 and 1997 were reviewed retrospectively. The following histologic factors were recorded: histologic type of tumor; number of nodes with metastatic deposits together with their nodal station; the presence of vascular invasion, visceral pleural involvement, and cellular necrosis; and grade of tumor. The results from 98 patients were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors.Results. Univariate analysis showed that only three factors had a statistically significant correlation with a poor prognosis: vascular invasion (p = 0.002), nonsquamous histology (p = 0.005), and visceral pleural involvement (P = 0.002). Multivariate analysis revealed that all three factors were significant independent adverse prognostic indicators.Conclusions. Visceral pleural involvement, nonsquamous histology, and vascular invasion are all significant adverse prognostic factors after surgical resection of T1-2N1M0 nonsmall cell cancer of the lung. These findings conflict with previously published reports, and we advocate a prospective, large-scale study in order to clarify the prognostic significance of histologic characteristics in stage II disease.