Relationship Between Pathologic T1 Categories and Pathologic Factors Affecting Prognosis in Pulmonary Adenocarcinoma.
Relationship Between Pathologic T1 Categories and Pathologic Factors Affecting Prognosis in Pulmonary Adenocarcinoma.
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DOI：
10.1016/j.jtocrr.2022.100293
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发表时间：
2022-04
影响因子：
--
通讯作者：
Ishikawa Y
中科院分区：
文献类型：
--
作者：
Ninomiya H;Inamura K;Mun M;Nishio M;Ishikawa Y
肺肿瘤的8个TNM分类比以往的分类系统提供了更准确的预后预测，特别是对侵犯范围小于或等于3 cm的T1肿瘤。T1分为T1a(6-10 mm)、T1b(11-20 mm)和T1c(21-30 mm)，但病理T(PT)1分类与其他病理因素的关系尚未得到深入研究。手术切除肺腺癌551例，其中pT1a~c 302例(pT1a：n=98，pT1b：n=156，pT1c：n=48)。病理因素，包括微小的微乳头或固体亚型，按新的T分类进行分析。采用单变量和多变量分析和COX比例风险模型评估无复发和疾病特异性生存(DSS)。从pT1a到pT1c，淋巴管侵袭、血管侵袭和淋巴结转移显著增加。内脏胸膜侵犯随着侵犯范围的增大从7%(6-10 mm)增加到33%(21-30 mm)。无复发生存率(RFS)和DSS从病理0、IA1和IA2期组恶化到IA3和IB期组。多因素分析显示，在pT1a~c的病例中，淋巴结转移和实体成分是影响RFS和DSS的独立预后因素。新的TNM分类可准确预测预后。肿瘤侵犯的大小与淋巴管和血管侵犯、淋巴结转移和内脏胸膜侵犯密切相关。作为一个次要因素，实体亚型是影响T1类患者术后RFS和DSS的一个强有力的不良预后因素。
The eight TNM classification of lung tumors provides a more precise prediction of prognosis than previous classification systems, especially in T1 tumors, the invasion size of which are less than or equal to 3 cm. T1 is divided into T1a (6–10 mm), T1b (11–20 mm), and T1c (21–30 mm), but the relationship between pathologic T (pT)1 categories and other pathologic factors has not been thoroughly evaluated. Surgically resected pulmonary adenocarcinomas (N = 551) were extracted on the basis of computed tomography-based tumor size measurements, including 302 pT1a to c cases (pT1a: n = 98, pT1b: n = 156, and pT1c: n = 48). Pathologic factors, including a minor component of micropapillary or solid subtype, were analyzed by new T categories. Recurrence-free and disease-specific survivals (DSSs) were evaluated using univariable and multivariable analyses and Cox proportional hazards models. Lymphatic invasion, vascular invasion, and nodal metastasis increased remarkably from pT1a to pT1c, step-wisely. Visceral pleural invasion was elevated from 7% (6–10 mm) to 33% (21–30 mm) along with an increase in invasion size. Recurrence-free survival (RFS) and DSS relevantly deteriorated from the group of pathologic stages 0, IA1, and IA2 to the group IA3 and IB. Multivariable analysis revealed that lymph node metastasis and solid components were independent prognostic factors for both RFS and DSS in pT1a to c cases. The new TNM classification precisely predicts prognosis. Tumor invasion size is closely associated with lymphatic and vascular invasion, nodal metastasis, and visceral pleural invasion. As a minor component, solid subtype was a potent adverse prognostic factor affecting both RFS and DSS after surgery in T1 categories.
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