Molecular pathologic substaging in 244 stage I non-small-cell lung cancer patients: Clinical implications
Molecular pathologic substaging in 244 stage I non-small-cell lung cancer patients: Clinical implications
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DOI：
10.1200/jco.1998.16.7.2468
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发表时间：
1998-07-01
影响因子：
45.3
通讯作者：
Sugarbaker, DJ
中科院分区：
文献类型：
--
作者：
Kwiatkowski, DJ;Harpole, DH;Sugarbaker, DJ
目的：回顾性建立I期非小细胞肺癌（NSCLC）复发的综合多因素模型，并设计分子病理亚分期系统。方法：对1984年至1992年间在布里格姆妇女医院（Boston， MA）接受手术并进行充分临床随访的所有I期非小细胞肺癌患者进行研究。研究了3个人口学特征、手术范围、11个病理特征和7个分子因素对无癌生存的重要性。结果：244例患者被研究，其中25例非癌症死亡，80例复发。60岁以上、男性、楔形切除、世界卫生组织（WHO）腺癌亚型实体瘤伴黏液蛋白、淋巴浸润和p53表达是癌症复发的显著单因素预测因子（P < 0.05）。多因素分析确定了9个独立的复发预测因素：粘蛋白实体瘤，楔形切除术；肿瘤直径≥4cm，淋巴浸润，年龄≥60岁，男性，p53表达，K-ras密码子12突变，H-ras p21缺失表达。对180例接受肺叶切除术或全肺切除术的患者进行多变量无癌生存（CFS）分析，排除了性别和年龄，只剩下6个独立因素。结论：一期非小细胞肺癌应行肺叶切除术或全肺切除术。利用复发性疾病的六个独立因素，我们提出了一个病理分子亚分期系统。2个或更少因素的患者分级为la级，5年CFS率为87%；有三个因素的患者分级为Ib， 5年CFS率为58%；有4个或更多因素的患者被评为Ic级，5年CFS率为21%。(C)美国临床肿瘤学会1998。
Purpose: To retrospectively construct a comprehensive multivariate model of cancer recurrence and to design a molecular pathologic substaging system in stage I non-small-cell lung cancer (NSCLC).Methods: All patients with stage I NSCLC resected at Brigham and Women's Hospital (Boston, MA) between 1984 and 1992 with adequate clinical follow-vp were studied. The importance of three demographic characteristics, surgical extent, 11 pathologic features, and seven molecular factors on cancer-free survival was examined.Results: Two hundred forty-four patients were studied, with 25 noncancer deaths and 80 patients with recurrent disease. Significant univariate predictors (P < .05) of cancer recurrence were age older than 60 years, male sex, wedge resection, World Health Organization (WHO) adenocarcinoma subtype solid tumor with mucin, lymphatic invasion, and p53 expression. Multivariate analysis identified nine independent predictors of recurrence: solid tumor with mucin, a wedge resection,;tumor diameter of 4 cm or greater, lymphatic invasion, age older than 60 years, male sex, p53 expression, K-ras codon 12 mutation, and absence of H-ras p21 expression. Multivariate cancer-free survival (CFS) analysis in the 180 patients who underwent lobectomy or pneumonectomy led to the elimination of sex and age, which left six independent factors.Conclusion: Lobectomy or pneumonectomy should be performed in stage I NSCLC. Using the six independent factors for recurrent disease, we propose a pathologic molecular substaging system. Patients with two factors or less are graded la, with a 5-year CFS rate of 87%; those with three factors are graded Ib, with a 5-year CFS rate of 58%; and those with four factors or more are graded Ic, with a 5-year CFS rate of 21%. (C) 1998 by American Society of Clinical Oncology.