Presence of Even a Small Ground-Glass Component in Lung Adenocarcinoma Predicts Better Survival
Presence of Even a Small Ground-Glass Component in Lung Adenocarcinoma Predicts Better Survival
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DOI：
10.1016/j.cllc.2017.06.020
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发表时间：
2018-01-01
影响因子：
3.6
通讯作者：
Shrager, Joseph
中科院分区：
文献类型：
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作者：
Berry, Mark F.;Gao, Rebecca;Shrager, Joseph
采用Kaplan-Meier和Cox分析方法，对123例临床上未行诱导治疗的N0肺腺癌患者行肺叶或叶下切除术，评估了以实体为主的肺腺癌中磨玻璃样小阴影成分对预后的影响。与100%实体瘤的患者相比，肿瘤中含有不到25%的微小磨玻璃成分的患者具有较少的病理分期和更好的5年总生存期。背景：虽然已知以麻风为主的肺腺癌比类似大小的实体瘤有更好的预后，但以实体瘤为主的较小的非侵袭性病灶的影响不太明显。我们测试了这样的假设，即即使是微小的磨玻璃样阴影(GGO)的肺腺癌比其他类似的纯固体(PS)腺癌的预后更好。患者和方法：对2003年5月至2013年8月间未接受诱导治疗的临床N0腺癌患者行叶或叶下切除的患者，通过术前计算机断层扫描确定其最大总直径和实体直径。用Kaplan-Meier和Cox分析比较PS肿瘤(0%GGO)和含有少量磨玻璃(MGG)的肿瘤(1%-25%GGO)患者的生存情况。结果：共有123例患者符合纳入标准，其中54例(44%)为PS，69例(56%)磨玻璃成分平均为18+/-7%。肿瘤实体成分直径分别为2.3±1.2 cm和2.5±1.3 cm，组间差异无统计学意义(P=.2)。PS组PN1-2分期更常见(13%[7/54]vs 3%[2/69]，P=0.04)，但两组病理分期分布无显著差异(PS 76%I期[41/54]vs MGG 80%I期[55/69]，P=.1)。在单变量分析(MGG 5年总生存率86.7%对PS 64.5%，P=.001)和多变量生存分析(风险比0.30，P=0.01)中，MGG成分与明显更好的生存率有关。结论：切除的cN0肺腺癌患者即使只有很小的GGO成分，其生存率也明显高于PS肿瘤患者，这可能对治疗和监测策略有一定的指导意义。
The impact of having a small ground-glass opacity component in an otherwise mostly solid lung adenocarcinoma at prognosis was evaluated using Kaplan-Meier and Cox analyses of 123 patients who underwent lobar or sublobar resection of clinical N0 lung adenocarcinomas without induction therapy. Patients with tumors that had a minor ground-glass component that comprised less than 25% of the overall tumor size had less pathologic upstaging and far better 5-year overall survival compared to patients who had a 100% solid cancer.Background: While lepidic-predominant lung adenocarcinomas are known to have better outcomes than similarly sized solid tumors, the impact of smaller noninvasive foci within predominantly solid tumors is less clearly characterized. We tested the hypothesis that lung adenocarcinomas with even a small ground-glass opacity (GGO) component have a better prognosis than otherwise similar pure solid (PS) adenocarcinomas. Patients and Methods: The maximum total and solid-component diameters were determined by preoperative computed tomography in patients who underwent lobar or sublobar resection of clinical N0 adenocarcinomas without induction therapy between May 2003 and August 2013. Survival between patients with PS tumors (0% GGO) or tumors with a minor ground-glass (MGG) component (1%-25% GGO) was compared by Kaplan-Meier and Cox analyses. Results: A total of 123 patients met the inclusion criteria, comprising 54 PS (44%) and 69 MGG (56%) whose mean ground-glass component was 18 +/- 7%. The solid component tumor diameter was not significantly different between the groups (2.3 +/- 1.2 cm vs. 2.5 +/- 1.3 cm, P = .2). Upstaging to pN1-2 was more common for the PS group (13% [7/54] vs. 3% [2/69], P = .04), but the distribution of pathologic stage was not significantly different between the groups (PS 76% stage I [41/54] vs. MGG 80% stage I [55/69], P = .1). Having a MGG component was associated with markedly better survival in both univariate analysis (MGG 5-year overall survival 86.7% vs. PS 64.5%, P = .001) and multivariable survival analysis (hazard ratio, 0.30, P = .01). Conclusion: Patients with resected cN0 lung adenocarcinoma who have even a small GGO component have markedly better survival than patients with PS tumors, which may have implications for both treatment and surveillance strategies.