Local Extension at the Hilum Region Is Associated With Worse Long-Term Survival in Stage I Non-Small Cell Lung Cancers INVITED COMMENTARY
Local Extension at the Hilum Region Is Associated With Worse Long-Term Survival in Stage I Non-Small Cell Lung Cancers INVITED COMMENTARY
复制标题
肺门区域的局部扩展与 I 期非小细胞肺癌的长期生存率较差相关
DOI：
10.1016/j.athoracsur.2011.09.079
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Gao, Wen
中科院分区：
文献类型：
--
作者：
Chen, Chang;Bao, Fang;Gao, Wen
背景非小细胞肺癌（NSCLC）的肺门结构浸润的预后意义，这仍然是不确定的，可能有潜在的应用癌症分期。肿瘤沿支气管和肺血管的沿着延伸被检查用于生存意义。共纳入213例经病理证实的中心型I期NSCLC病例。根据切除范围分为4个研究组：标准肺叶切除术（L组，n = 32）、支气管成形术（B组，n = 94）、标准肺叶切除术联合肺血管成形术（A组，n = 48）和支气管袖状切除术联合肺动脉血管成形术（BA组，n = 39）。采用Kaplan-Meier法和考克斯回归模型进行单因素和多因素分析。术后死亡2例（肺栓塞和严重肺部感染）。并发症39例（18.3%）。在这些患者中，总体5年生存率为60.2% +/-0.05%，中位生存时间为75.0 +/- 7.5个月。L、B、A、BA组5年生存率分别为79.5%、59.7%、59.0%、47.9%。单因素分析显示肿瘤大小、支气管侵犯、动脉受累和手术类型与长期生存率密切相关。多因素分析显示，手术方式和肿瘤大小是影响5年生存率的主要预后因素。近端肿瘤扩展到支气管、心包外肺血管浸润和肿瘤大小是影响中心型I期NSCLC 5年生存率的最重要危险因素。肿瘤在门部的扩展与预后高度相关，并且可以提供相关信息以准确地定义肿瘤（“T”）亚类。(Ann Thorac Surg 2012;93：389-97）（C）2012年，胸外科医师协会
Background. The prognostic significance of hilar structures invasion, which remains undefined for non-small cell lung cancer (NSCLC), may have potential application for cancer staging. Tumor extension along the bronchus and pulmonary vessels was examined for survival significance.Methods. In all, 213 pathologically proved central-type stage I NSCLC cases were enrolled. Four study groups were assigned based on the extent of resections: standard lobectomy (group L, n = 32), bronchoplastic procedures (group B, n = 94), standard lobectomy combined with pulmonary angioplasty (group A, n = 48), and bronchial sleeve resection combined with pulmonary artery angioplasty (group BA, n = 39). Univariate and multivariate analysis were performed by the Kaplan-Meier method and the Cox regression model.Results. There were 2 postoperative deaths (pulmonary embolism and serious pulmonary infection). Complications were noted in 39 patients (18.3%). Among these patients, the overall 5-year survival rate was 60.2% +/- 0.05%, with a median survival time of 75.0 +/- 7.5 months. The 5-year survival rates of subgroups were 79.5%, 59.7%, 59.0%, and 47.9%, respectively for groups L, B, A, and BA. Univariate analysis indicated tumor size, bronchial invasion, arterial involvement, and type of operation as closely associated with long-term survival. Multivariate analysis indicated that type of operation and tumor size were the most prominent prognostic factors of 5-year survival.Conclusions. Proximal tumor extension into bronchus, invasions into extrapericardial pulmonary vessels, and tumor size were the most important risk factors for 5-year survival with central-type stage I NSCLC. Tumor extension in the hilum was highly related to prognosis and might provide pertinent information to accurately define a tumor ("T") subclass. (Ann Thorac Surg 2012;93:389-97) (C) 2012 by The Society of Thoracic Surgeons