Ⅰ期肺腺癌伴脉管癌栓相关因素分析
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摘要
目的分析Ⅰ期肺腺癌伴脉管癌栓发生的相关因素。方法回顾性分析2016年1月—2018年5月于天津市胸科医院胸外科行手术治疗、且术后病理确诊为Ⅰ期肺腺癌的229例患者的临床病理资料。患者按照是否伴有脉管癌栓分为脉管癌栓组和非脉管癌栓组。分析发生脉管癌栓的影响因素。结果单因素分析显示,Ⅰ期肺腺癌伴脉管癌栓发生与肿瘤直径、附壁成分、腺泡成分、乳头成分、微乳头成分、伴有脏层胸膜侵犯、术前中性粒细胞/淋巴细胞(NLR)、术前癌胚抗原(CEA)有关(P<0.05)。多因素分析结果显示,肿瘤直径≥2.2 cm、微乳头成分≥12.8%、脏层胸膜侵犯为脉管癌栓发生的独立危险因素。结论临床中应重视肿瘤直径、微乳头成分、脏层胸膜侵犯等影响脉管癌栓发生的危险因素,对伴脉管癌栓的患者尽早进行针对性的治疗,使患者生存期延长。
Objective To investigate the related factors of stage I pulmonary adenocarcinoma with lymphovascular invasion. Methods Clinical data of 229 patients with stage I lung adenocarinoma treated by surgical treatment and pathologically diagnosed as stage I lung adenocarcinoma in Tianjin Chest Hospital from January 2016 to May 2018 were retrospectively analyzed. The patients were divided into two groups: lymphovascular invasion group and non-lymphovascular invasion group, and the influencing factors of lymphovascular invasion for lung adenocarcinoma in stage I were analyzed.Results The univariate factor analysis showed that pulmonary adenocarcinoma in stage I with lymphovascular invasion was related to diameter of tumor, lepidic pattern, acinar pattern, papillary pattern, micropapillary pattern, pleural invasion,preoperative neutrophil-lymphocyte ratio(NLR) and preoperative carcinoembryonic antigen(CEA, P<0.05). Multivariate Logistic regression analysis showed that diameter of tumor ≥ 2.2 cm, micropapillary pattern ≥ 12.8% and pleural invasion were the risk factors for lymphovascular invasion. Conclusion Attention should be paid to the risk factors of lymphovascular invasion in clinic, such as tumor diameter, micropapillary pattern and visceral pleural invasion. And the patients with lymphovasular invasion should be treated as early as possible so as to prolong their survival time.
Objective To investigate the related factors of stage I pulmonary adenocarcinoma with lymphovascular invasion. Methods Clinical data of 229 patients with stage I lung adenocarinoma treated by surgical treatment and pathologically diagnosed as stage I lung adenocarcinoma in Tianjin Chest Hospital from January 2016 to May 2018 were retrospectively analyzed. The patients were divided into two groups: lymphovascular invasion group and non-lymphovascular invasion group, and the influencing factors of lymphovascular invasion for lung adenocarcinoma in stage I were analyzed.Results The univariate factor analysis showed that pulmonary adenocarcinoma in stage I with lymphovascular invasion was related to diameter of tumor, lepidic pattern, acinar pattern, papillary pattern, micropapillary pattern, pleural invasion,preoperative neutrophil-lymphocyte ratio(NLR) and preoperative carcinoembryonic antigen(CEA, P<0.05). Multivariate Logistic regression analysis showed that diameter of tumor ≥ 2.2 cm, micropapillary pattern ≥ 12.8% and pleural invasion were the risk factors for lymphovascular invasion. Conclusion Attention should be paid to the risk factors of lymphovascular invasion in clinic, such as tumor diameter, micropapillary pattern and visceral pleural invasion. And the patients with lymphovasular invasion should be treated as early as possible so as to prolong their survival time.
引文
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[7]杜林,卢喜科,张逊,等.对于肺腺癌形态及成分与淋巴结转移规律的关系[J].中华胸心血管外科杂志,2017,33(7):530-533.Du L,Lu XK,Zhang X,et al. Correlation factors of N1 lymph nodemetastasis in patients with lung adenocarcinoma[J]. Chin JThoracic Cardiovasc Surg,2017,33(7):530-533. doi:10.3760/cma.j.issn.1001-4497.2017.09.005.
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[9] Zombori T,Nyári T,Tiszlavicz L,et al. The more the micropapillarypattern in stage I lung adenocarcinoma,the worse the prognosis-aretrospective study on digitalized slides[J]. Virchows Arch,2018,472(6):949-958. doi:10.1007/s00428-018-2337-x.
[10]王烈,续力云,刘超武,等.肺腺癌上皮-间质转化相关标识基因检测的临床意义[J].浙江医学,2018,40(7):696-700. Wang L,Xu LY,Lu CW,et al. Detection of epithelial-mesenchymaltransition-related genes in lung adenocarcinoma and its significance[J]. Zhejiang Medical Journal,2018,40(7):696-700. doi:10.12056/j.issn.1006-2785.2018.40.7.2017-532.
[11]Lee MC,Buitrago DH,Kadota K,et al. Recent advances andclinical implications of the micropapillary histological subtype inlung adenocarcinomas[J]. Lung Cancer Manag,2014,3(3):245-253.
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[13]Tao H,Hayashi T,Sano F,et al. Prognostic impact oflymphovascular invasion compared with that of visceral pleuralinvasion in patients with pN0 non-small-cell lung cancer and atumor diameter of 2 cm or smaller[J]. J Surg Res,2013,185(1):250-254. doi:10.1016/j.jss.2013.05.104.
[14]Riquet M,Badoual C,Le Pimpec Barthes F,et al. Visceral pleurainvasion and pleural lavage tumor cytology by lung cancer:aprospective appraisal[J]. Ann Thorac Surg,2003,75(2):353-355.
[15]Al-Alao BS,Gately K,Nicholson S,et al. Prognostic impact ofvascular and lymphovascular invasion in early lung cancer[J].Asian Cardiovasc Thorac Ann,2014,22(1):55-64. doi:10.1177/0218492313478431.
[2]Ding N,Mao Y,Gao S,et al. Predictors of lymph node metastasis andpossible selective lymph node dissection in clinical stage IA non-small cell lung cancer[J]. J Thorac Dis,2018,10(7):4061-4068.doi:10.21037/jtd.2018.06.129.
[3]彭胜祖,李晓,王云,等.术后辅助化疗对Ⅰ期非小细胞肺癌无瘤生存时间的影响[J].中国肺癌杂志,2017,20(7):485-489.Peng SZ,Li X,Wang Y,et al. Effect of Adjuvant Chemotherapy onDFS for Patients with StageⅠNSCLC[J]. Chin J Lung Cancer,2017,20(7):485-489. doi:10.3779/j.issn.1009-3419.2017.07.10.
[4]张殿彩,李强,杨力,等.影响1 260例胃癌脉管癌栓形成的临床病理因素分析[J].中华消化外科杂志,2017,16(3):269-274.Zhang DC,Li Q,Yang L,et al. Analysis of clinicopathologic factorsaffecting formation of lymphovascular invasion in 1 260 patients with gastric cancer[J]. Chin J Dig Surg,2017,16(3):269-274.doi:10.3760/cma.j.issn.1673-9752.2017.03.010.
[5]杨玉赏,胡伟鹏,陈龙奇.脉管癌栓对食管鳞状细胞癌预后的影响[J].中华胸心血管外科杂志,2015,31(11):656-659. YangYS,Hu WP,Chen LQ. Angiolymphatic invasion as a prognosticpredictor after radical resection of esophageal squamous cellcarcinoma[J]. Chin J Thoracic Cardiovasc Surg,2015,31(11):656-659. doi:10.3760/cma.j.issn.1001-4497.2015.11.005.
[6] Travis WD,Brambilla E,Noguchi M,et al. InternationalAssociation for the Study of Lung Cancer/American ThoracicSociety/European Respiratory Society:internationalmultidisciplinary classification of lung adenocarcinoma:executivesummary[J]. Proc Am Thorac Soc,2011,8(5):381-385. doi:10.1513/pats.201107-042ST.
[7]杜林,卢喜科,张逊,等.对于肺腺癌形态及成分与淋巴结转移规律的关系[J].中华胸心血管外科杂志,2017,33(7):530-533.Du L,Lu XK,Zhang X,et al. Correlation factors of N1 lymph nodemetastasis in patients with lung adenocarcinoma[J]. Chin JThoracic Cardiovasc Surg,2017,33(7):530-533. doi:10.3760/cma.j.issn.1001-4497.2017.09.005.
[8] Tsubokawa N,Mimae T,Sasada S,et al. Negative prognosticinfluence of micropapillary pattern in stage IA lung adenocarcinoma[J]. Eur J Cardiothorac Surg,2016,49(1):293-299. doi:10.1093/ejcts/ezv058.
[9] Zombori T,Nyári T,Tiszlavicz L,et al. The more the micropapillarypattern in stage I lung adenocarcinoma,the worse the prognosis-aretrospective study on digitalized slides[J]. Virchows Arch,2018,472(6):949-958. doi:10.1007/s00428-018-2337-x.
[10]王烈,续力云,刘超武,等.肺腺癌上皮-间质转化相关标识基因检测的临床意义[J].浙江医学,2018,40(7):696-700. Wang L,Xu LY,Lu CW,et al. Detection of epithelial-mesenchymaltransition-related genes in lung adenocarcinoma and its significance[J]. Zhejiang Medical Journal,2018,40(7):696-700. doi:10.12056/j.issn.1006-2785.2018.40.7.2017-532.
[11]Lee MC,Buitrago DH,Kadota K,et al. Recent advances andclinical implications of the micropapillary histological subtype inlung adenocarcinomas[J]. Lung Cancer Manag,2014,3(3):245-253.
[12]Huang H,Wang T,Hu B,et al. Visceral pleural invasion remains asize-independent prognostic factor in stage I non-small cell lungcancer[J]. Ann Thorac Surg,2015,99(4):1130-1139. doi:10.1016/j.athoracsur.2014.11.052.
[13]Tao H,Hayashi T,Sano F,et al. Prognostic impact oflymphovascular invasion compared with that of visceral pleuralinvasion in patients with pN0 non-small-cell lung cancer and atumor diameter of 2 cm or smaller[J]. J Surg Res,2013,185(1):250-254. doi:10.1016/j.jss.2013.05.104.
[14]Riquet M,Badoual C,Le Pimpec Barthes F,et al. Visceral pleurainvasion and pleural lavage tumor cytology by lung cancer:aprospective appraisal[J]. Ann Thorac Surg,2003,75(2):353-355.
[15]Al-Alao BS,Gately K,Nicholson S,et al. Prognostic impact ofvascular and lymphovascular invasion in early lung cancer[J].Asian Cardiovasc Thorac Ann,2014,22(1):55-64. doi:10.1177/0218492313478431.
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