Predicting the recurrencerisk factors and clinical outcomes of peripheral pulmonary adenocarcinoma ≤3cm with wedge resection.
Predicting the recurrencerisk factors and clinical outcomes of peripheral pulmonary adenocarcinoma ≤3cm with wedge resection.
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楔形切除术预测≥3cm周围型肺腺癌的复发危险因素和临床结果
DOI：
10.1007/s00432-016-2337-7
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Chen H
中科院分区：
文献类型：
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作者：
Luo J;Wang R;Han B;Zhang J;Zhao H;Fang W;Luo Q;Yang J;Yang Y;Zhu L;Chen T;Cheng X;Huang Q;Wang Y;Zheng J;Chen H
本研究旨在利用上海市胸科医院肺癌数据库，对临床I期肺腺癌楔形切除术后复发和生存的危险因素进行研究。依次进行单因素和多因素Cox比例风险回归分析，筛选出有意义的危险因素，并分别建立RFS、OS和LCS的诺模图和协调指数。结果临床I期腺癌楔形切除的5年RFS、OS和LCS分别为86.1%、83.6%和85.2%。经Cox回归分析，有3个独立的危险因素(性别、病理、胸膜侵犯)、2个与OS(性别、体积比)、2个与LCS(性别、体积比)有关，并选择建立诺模图。C指数分别为0.767(95%可信区间0.667~0.867)、0.782(95%可信区间0.660~0.904)和0.794(95%可信区间0.669~0.919)。结论性别、病理和胸膜侵犯可作为临床I期腺癌楔形切除的标准。楔形体积越大和/或肿瘤体积越小，OS和LCS越好。如果体积比达到10：1或以上，OS和LCS的存活率约为90%。对于WR，尤其是侵袭性腺癌，是否有必要进行淋巴清扫，尚需进一步研究。
PurposeThis study was designed to investigate the risk factors of recurrence and survival of clinical stage I lung adenocarcinoma underwent wedge resection by the use of Shanghai Chest Hospital Lung Cancer Database.Patients and methodsA total of 746 patients with clinical stage I adenocarcinoma underwent wedge resection from 2010 to 2015 in our database were included in this study. Univariable and multivariable Cox proportional hazards regression were performed successively to select significant risk factors and then nomograms as well as the concordance indexes for RFS, OS and LCSS were developed, respectively. Kaplan–Meier survival curves were performed if necessary, with the identification of log-rank test.ResultsThe 5-year RFS, OS and LCSS of clinical stage I adenocarcinoma underwent wedge resection were 86.1, 83.6 and 85.2%, respectively. There were three independent risk factors related with RFS (sex, pathology, pleural invasion), two related with OS (sex, volume ratio) and two with LCSS (sex, volume ratio) with the analysis of Cox regression and were selected to develop nomograms. The C-indexes of RFS, OS and LCSS were 0.767 (95% CI 0.667–0.867), 0.782 (95% CI 0.660–0.904) and 0.794 (95% CI 0.669–0.919), respectively. Lymphadenectomy did not show differences statistically but had tendencies of better RFS, OS and LCSS among the subgroup of invasive adenocarcinoma.ConclusionSex, pathology and pleural invasion could be recommended as criteria for clinical stage I adenocarcinoma undergoing wedge resection. And the larger the wedge volume and/or the smaller the tumor volume was, the better OS and LCSS were. If the volume ratio reached 10:1 or more, the survival rate was approximately 90% for both OS and LCSS. Whether lymphadenectomy was necessary for WR, especially in invasive adenocarcinoma, needed further research.