A retrospective study on the relationship between IASLC grading system and prognosis in patients with stage I invasive non-mucinous lung adenocarcinoma
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摘要:
目的 回顾性分析国际肺癌研究协会（IASLC）分级系统与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性及与患者预后的关系。 方法 回顾性分析2015年1月至2018年12月就诊于天津市胸科医院的204例Ⅰ期浸润性非黏液型肺腺癌患者的临床病理资料及随访资料，根据IASLC分级系统对患者分组，采用单因素方差分析、χ2检验和Fisher精确检验分析IASLC分级与Ⅰ期浸润性非黏液型肺腺癌临床病理特征的相关性，及与肺腺癌患者预后的关系。通过Kaplan-Meier法计算浸润性非黏液型肺腺癌患者总生存率（overall survival，OS）、无复发生存率（recurrence-free survival，RFS）；采用Log-rank法比较不同组间的差异性。使用单因素Cox回归、多因素Cox回归分析独立危险因素。 结果 204例患者中IASLC分级为Ⅰ级108例，Ⅱ级66例，Ⅲ级30例。IASLC分级与性别（P=0.022）、吸烟史（P=0.041）、脉管侵犯（P=0.004）、胸膜累及（P=0.001）、病理分期（P<0.001）、肿瘤直径（P<0.001）均显著相关。单因素生存分析结果显示，胸膜累及（P=0.043）与IASLC分级（P<0.001）均对OS有显著影响；IASLC分级对RFS有显著影响（P<0.001）。多因素Cox回归分析显示肿瘤直径（P=0.005）与IASLC分级（P=0.002）是影响Ⅰ期肺腺癌患者OS的独立危险因素；肿瘤直径（P=0.007）、IASLC分级（P=0.003）是Ⅰ期肺腺癌患者RFS的独立危险因素。 结论 IASLC分级为Ⅰ期浸润性非黏液型肺腺癌预后的独立预后因素，IASLC分级越高Ⅰ期浸润性非黏液型肺腺癌患者预后越差。该分级系统提供了一个新的预后分组模式，为Ⅰ期浸润性非黏液型肺腺癌患者的术后管理及治疗提供新思路。 Abstract:Objective To retrospectively analyze the correlation between the International Association for the Study of Lung Cancer (IASLC) grading system and clinicopathological features of stage I invasive non-mucinous lung adenocarcinoma, and its impact on the prognosis of the patients. Methods The clinicopathological and follow-up data of 204 patients with stage I invasive non-mucinous lung adenocarcinoma, who were enrolled in Tianjin Chest Hospital from January 2015 to December 2018, was collected and analyzed. The patients were assigned into groups according to the IASLC grading system. One-way ANOVA, the Chi-square test, and the Fisher's exact test were used to analyze the correlation between the IASLC grading system, and the clinicopathological characteristics of stage I invasive non-mucinous lung adenocarcinoma, and the impact of the IASLC grading system on the prognosis and recurrence of patients with invasive non-mucinous lung adenocarcinoma. The overall survival (OS) rate and recurrence-free survival (RFS) rate of patients with invasive non-mucinous lung adenocarcinoma was calculated using the Kaplan–Meier method. The Log-rank test was used to compare the differences between different groups. Independent risk factors were analyzed using univariate and multivariate Cox regressions. Results Of the 204 patients with stage Ⅰ invasive non-mucinous lung adenocarcinoma, 108 were grade Ⅰ; 66, grade Ⅱ; and 30, grade Ⅲ tumors. IASLC grade was significantly correlated with sex (P=0.022), smoking history (P=0.041), vascular invasion (P=0.004), pleural involvement (P=0.001), pathological stage (P<0.001), and tumor diameter (P<0.001). Results from the univariate survival analysis showed that the pleural involvement (P=0.043) and IASLC grade (P<0.001) had significant effects on OS, while the IASLC grade had a significant impact on RFS (P<0.001). Moreover, multivariate Cox regression analysis showed that tumor diameter (P=0.005) and IASLC grade (P=0.002) were independent risk factors for OS of patients with stage I invasive non-mucinous lung adenocarcinoma, while the tumor diameter (P=0.007) and IASLC grade (P=0.003) were independent factors for recurrence in patients with stage I invasive non-mucinous lung adenocarcinoma. Conclusions The IASLC grading system is an independent prognostic factor for stage I invasive non-mucinous lung adenocarcinoma. The higher the IASLC grade, the worse the prognosis of patients with stage I invasive non-mucinous lung adenocarcinoma. The grading system provides a new prognostic grouping method and a new approach to postoperative management and treatment of patients with stage I invasive non-mucinous lung adenocarcinoma. -
Key words:
- lung adenocarcinoma /
- IASLC grade /
- prognosis
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表 1 IASLC 分级与临床病理特征的关系
项目 IASLC分级 例（%） P χ2 Ⅰ Ⅱ Ⅲ 性别 0.022 7.666 男 45（41.7） 30（45.5） 21（70） 女 63（58.3） 36（54.5） 9（30） 吸烟史 0.041 6.368 无 72（66.7） 45（68.2） 13（43.3） 有 36（33.3） 21（31.8） 17（56.7） 脉管侵犯 0.004 11.246 无 42（38.9） 10（15.2） 8（26.7） 有 66（61.1） 56（84.8） 22（73.3） 胸膜累及 0.001 14.070 无 87（80.6） 37（56.1） 17（56.7） 有 21（19.4） 29（43.9） 13（43.3） 病理分期（期） <0.001 16.435 ⅠA 86（79.6） 34（51.5） 17（56.7） ⅠB 22（20.4） 32（48.5） 13（43.3） 部位 0.430* 7.948 左肺上叶 24（22.2） 19（28.8） 6（20.0） 左肺下叶 18（16.7） 11（16.7） 2（6.7） 右肺上叶 45（41.7） 20（30.3） 12（40.0） 右肺中叶 4（3.7） 4（6.1） 4（13.3） 右肺下叶 17（15.7） 12（18.2） 6（3.3） *：采用Fisher精确检验 
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表 2 Ⅰ期肺腺癌术后的生存分析
项目 OS RFS 平均时间（月） P 平均时间（月） P 性别 0.308 0.356 男 67.11 59.18 女 73.32 61.51 吸烟史 0.319 0.960 无 73.22 60.61 有 65.07 60.49 脉管侵犯 0.922 0.184 无 63.19 60.70 有 72.84 59.85 胸膜累及 0.043 0.102 无 73.73 60.33 有 64.08 57.66 病理分期（期） 0.068 0.766 ⅠA 73.72 59.56 ⅠB 63.76 59.29 部位 0.782 0.996 左肺上叶 67.85 61.03 左肺下叶 71.69 59.25 右肺上叶 67.49 60.15 右肺中叶 60.54 57.02 右肺下叶 59.95 56.24 IASLC分级（级） <0.001 <0.001 Ⅰ 75.31 64.91 Ⅱ 65.34 56.87 Ⅲ 59.85 50.06 OS：累积生存时间；DFS：无病生存时间
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表 3 OS的单因素和多因素分析
项目 单因素分析 多因素分析 HR 95%CI P HR 95%CI P 年龄 1.024 0.981～1.068 0.284 — — — 性别 0.313 — 男 1.645 0.626～4.322 — — 女 1.000 — — — 吸烟史 0.324 — 无 1.000 — — — 有 1.616 0.623～4.188 — — 肿瘤直径 4.744 1.643～13.698 0.004 2.482 1.323～4.656 0.005 脉管侵犯 0.922 — 无 1.000 — — — 有 0.949 0.334～2.695 — — 胸膜累及 0.051 — 无 1.000 — — — 有 2.578 0.995～6.684 — — 病理分期（期） 0.766 — ⅠA 1.000 — — — ⅠB 2.367 0.913～6.137 — — 部位 — 左肺上叶 1.000 — 0.803 — — 左肺下叶 2.433 0.406～14.567 0.330 — — 右肺上叶 2.334 0.485～11.248 0.291 — — 右肺中叶 2.086 0.189～23.040 0.548 — — 右肺下叶 2.940 0.538～16.059 0.213 — — IALSC分级（级） Ⅰ 1.000 — 0.001 1.000 — 0.002 Ⅱ 3.456 0.864～13.821 0.080 2.366 0.584～9.588 0.228 Ⅲ 11.721 3.104～44.252 <0.001 8.891 2.331～33.907 0.001
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表 4 RFS的单因素和多因素分析
项目 单因素分析 多因素分析 HR 95%CI P HR 95%CI P 年龄 1.024 0.981～1.068 0.284 — — — 性别 0.358 — 男 1.338 0.719～2.491 — — 女 1.000 — — — 吸烟史 0.960 — 无 1.000 — — — 有 1.017 0.530～1.950 — — 肿瘤直径 1.922 1.319～2.801 0.001 1.757 1.169～2.641 0.007 脉管侵犯 0.189 — 无 1.000 — — — 有 1.681 0.774～3.649 — — 胸膜累及 0.106 — 无 1.000 — — — 有 1.682 0.895～3.159 — — 病理分期（期） 0.766 — ⅠA 1.000 — — — ⅠB 1.104 0.575～2.118 — — 部位 — 左肺上叶 1.000 — 0.996 — — 左肺下叶 0.962 0.342～2.707 0.941 — — 右肺上叶 1.025 0.448～2.344 0.953 — — 右肺中叶 1.220 0.330～4.510 0.765 — — 右肺下叶 1.127 0.419-3.028 0.813 — — IALSC分级（级） Ⅰ 1.000 — 0.001 1.000 — 0.003 Ⅱ 3.221 1.519～6.830 0.002 2.509 1.163～5.415 0.019 Ⅲ 4.692 2.031～10.839 <0.001 4.195 1.809～9.728 0.001
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