摘要
目的 探讨早期肺腺癌患者发生气腔播散(STAS)的临床病理特征及预后.方法 回顾性收集2015-01-01-2017-12-21在河北医科大学第一医院胸外科接受肺切除术的554例肿瘤长径≤3 cm肺腺癌患者(pT1a-c)资料,其中男261例,女293例.年龄31～79岁,中位年龄61岁.采用Mann-Whitney U检验、x2检验和Fisher确切概率法及二元logistic回归分析法分析预后及影响STAS发生的关联因素.结果 Ⅰ A期(pT1a-cN0M0)肺腺癌患者307例,其中男137例(44.6％),女170例(55.4％),发生STAS 71例,阳性率为23.1％.在Ⅰ A期肺腺癌患者中,STAS与肿瘤实性成分比例(CTR,Z=-2.245,P=0.025)、脉管瘤栓(x2=46.512,P＜0.001)、不同病理类型(x2=6.782,P=0.011)、存在微乳头成分(Z=-4.569,P＜0.001)及病理亚型中附壁成分缺失(x2=4.237,P=0.040)有关联.在554例入组患者中,单因素分析结果显示,STAS与脉管瘤栓、胸膜侵犯、淋巴结转移、N分期有关联(均P＜0.05).多因素分析结果显示,脉管瘤栓(OR=0.513,95％CI:0.301～0.874,P=0.014)和胸膜浸润(OR=20.475,95％CI:9.727～43.099,P＜0.001)是STAS出现的独立风险因素.生存分析结果显示,STAS阳性患者表现为更差的无复发生存期和总生存期,均P＜0.05.结论 STAS是早期肺腺癌的不良预后因素,且与更具侵袭性的临床病理特征如CTR、胸膜侵犯、脉管瘤栓、微乳头成分和淋巴结转移等有关.
Abstract
Objective To investigate the clinicopathological risk factors and prognosis of spread through air space(STAS)in early lung adenocarcinoma.Methods Retrospective collection of data from 554 patients with lung adenocarcinoma with a tumor diameter ≤3 cm(pT1a-c)who underwent pulmonary resection at the Department of Thoracic Surgery,First Hospi-tal of Hebei Medical University from January 2015 to December 21,2017.Among them,there were 261 males and 293 females,aged 31-79 years,with a median age of 61 years.Mann Whitney U test,x2-test,Fisher exact probability meth-od,and binary logistic regression analysis were used to analyze the prognosis and associated factors affecting the occurrence of STAS.Results Totally 307 patients with stage Ⅰ A(pT1a-cN0M0)lung adenocarcinoma,including 137 males(44.6％)and 170 females(55.4％),developed STAS in 71 cases,with a positive rate of 23.1％.In stage Ⅰ A lung ade-nocarcinoma patients,the ratio of STAS to tumor solid components(CTR,Z=-2.245,P=0.025),vascular tumor thrombus(x2=46.512,P＜0.001),different pathological types(x2=6.782,P=0.011),presence of micropapillary components(Z=-4.569,P＜0.001),and absence of adherent components in pathological subtypes(x2=4.237,P=0.040)were associated.Among all enrolled patients with T≤3 cm(pT1a-c),univariate analysis showed that STAS was associated with vascular thrombosis,pleural invasion,lymph node metastasis,and N-stage(all P＜0.05).The results of multivariate analysis showed that vascular tumor thrombus(OR=0.513,95％CI:0.301-0.874,P=0.014)and pleural infiltration(OR=20.475,95％CI:9.727-43.099,P＜0.001)were independent risk factors for the occurrence of STAS.The survival analysis results showed that STAS positive patients had poorer recurrence free survival and overall survival,both P＜0.05.Conclusion STAS is a poor prognostic factor for early lung adenocarcinoma and is associated with more invasive clinical and pathological features such as CTR,pleural infiltration,vascular tumor thrombus,micro-papillary components,and lymph node metastasis.
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