脏层胸膜侵犯和脉管癌栓对非小细胞肺癌术后初始复发部位及预后的影响

摘要

背景与目的：脏层胸膜侵犯(visceral pleural invasion，VPI)和脉管癌栓(vessel invasion，VI)是非小细胞肺癌(non-small cell lung cancer，NSCLC)患者预后的危险因素，前者的初始复发部位可能以局部复发为主，而后者可能以远处转移多见。本研究主要探讨VPI和VI对初始复发部位及术后生存率的影响。方法：回顾性分析广西医科大学附属肿瘤医院2007年1月—2013年12月期间住院的NSCLC手术治疗患者的完整资料共计290例。VPI患者51例，无VPI患者239例；有VI患者29例，无VI患者261例，分别比较其临床特征、总生存期(overall survival，OS)及无病生存期(disease-free survival，DFS)的差异。结果：VPI组与无VPI组的肿瘤大小、淋巴结转移、TNM病理分期和初始复发部位相比，差异有统计学意义(P<0.05)。VI组与无VI组的淋巴结转移和TNM病理分期相比，差异有统计学意义(P<0.05)。VPI组的1年、3年和5年生存率(88.2%、56.7%和52.7%)均低于无VPI组(95.8%、83.7%和74.0%)，差异有统计学意义(P<0.001)。VI组的1年、3年和5年生存率(79.3%、56.8%和48.7%)均低于无VI组(96.1%、81.3%和72.3%)，差异有统计学意义(P=0.001)。Cox多因素分析结果显示，TNM病理分期是患者DFS的独立影响因素(P<0.05)。淋巴结转移、VPI是患者OS的独立影响因素(P<0.05)。结论：VPI患者的初始复发部位以局部复发多见；VPI和VI的NSCLC患者预后均较差，需要更积极的术后治疗。%Background and purpose:Visceral pleural invasion (VPI) and vessel invasion (VI) are poor prognostic factors in patients with non-small cell lung cancer (NSCLC). The primary initial recurrence site may be local recurrence in VPI and distant metastasis in VI. The purpose of this study was to validate the prognostic impact and effect of the initial recurrence site of VPI and VI on survival outcomes for NSCLC.Methods:Two hundred and ninety patients who were diagnosed as having NSCLC and underwent lobectomy between Jan. 2007 and Dec. 2013 were retrospectively analyzed. VPI was identiifed in 51 patients as VPI group, the other 239 patients without VPI as non-VPI group. VI was identiifed in 29 patients as VI group, the other 261 patients without VI as non-VI group. Clinical characteristics, overall survival (OS), disease-free survival (DFS) were compared.Results:There were statistically signiifcant differences between VPI group and non-VPI group in tumor size, lymph node metastasis, TNM stage and initial recurrence site (P<0.05). Furthermore, there were statistically signiifcant differences between VI group and non-VI group in lymph node metastasis and TNM stage (P<0.05). The 1-, 3- and 5-year OS rates in VPI group (88.2%, 56.7% and 52.7%) were lower than those in non-VPI group (95.8%, 83.7% and 74.0%,P<0.001). The 1-, 3- and 5-year OS rates in VI group (79.3%, 56.8% and 48.7%) were lower than those in non-VI group (96.1%, 81.3% and 72.3%,P=0.001). Cox regression showed TNM stage was a significant prognostic factor for DFS, whereas lymph node metastasis and VPI were signiifcant prognostic factors in patients with NSCLC.Conclusion:The primary initial recurrence site in VPI patients is local recurrence. Patients with VPI or VI may need more postoperative therapy because of their poor prognosis.