pT1期肺腺癌间质浸润的分级及预后意义

目的 探讨TNM病理分期T1(pathologic-T1,pT1)期肺腺癌中间质浸润分级的预后意义.方法 选择具有完整临床病理及随访资料结果 的pT1期肺腺癌85例,根据间质浸润在肿瘤中的部位将每例肿瘤中间质浸润的程度分为1-3级,分析各间质浸润级别病例的临床病理特征及预后.结果 间质浸润各级别肿瘤的病例数为1级:17例(20%),2级:12例(14%),3级:56例(66%).临床病理特征:肿瘤大小及淋巴血管侵犯率除1级病例小于3级病例(P值分别为0.005及0.018)外其余各级病例间的差异无统计学意义.淋巴结转移率及病理学分期在1级和2级病例完全相同并低于3级病例(1级与3级P值分别为0.007及0.002;2级与3级P值分别为0.027及0.021).性别、年龄及吸烟史各级病例间的差异无统计学意义.预后:本组病例5年总生存率是63%.1-3级病例的5年生存率分别为100%、83.3%及46.6%,2级与3级病例间的差异有统计学意义(P=0.027),随访期间病死率1-3级病例分别为0、16.7%及42.9%,1级与3级病例间的差异有统计学意义(P=0.001),而与2级病例间的差异无统计学意义.单因素预后分析提示间质浸润分级(P=0.001)、病理学分期(P<0.001)、淋巴血管侵犯(P<0.001)及淋巴结转移(P<0.001)与预后相关.多因素预后分析提示仅病理学分期(P<0.001)为独立预后因素.结论 间质浸润分级是一个与肿瘤预后及其他预后因素均密切相关组织学分级系统,它可作为pT1期肺腺癌预后分类的标准之一.

Prognostic significance and grading of stromal invasion in pT1 adenocarinoma of lung

Objective To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage Tl (pTl) adenocarcinoma of lung.Methods Eighty-five cases of surgically resected pTl lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed.The degree of invasive growth was classified into three grades according to its location in the tumor.The clinicopathologic characteristics and prognostic significance were analyzed.Results Amongst the 85 cases studied,17 cases (20% ) were in grade 1,12 (14% ) in grade 2 and 56 (66% ) in grade 3.The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P =0.005 for tumor size and P =0.018 for occurrence of lymphovascular permeation).The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 ( P = 0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors,P = 0.002 for pathologic stage in grade 1 versus grade 3 tumors,P = 0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P =0.021 for pathologic stage in grade 2 versus grade 3 tumors).There was no statistically significant difference with respect to age,gender and smoking history of the patients,amongst cases in different grades.The overall five-year survival rate was 63%.The five-year survival rates for cases with grade 1,grade 2 and grade 3 were 100% ,83.3% and 46.6% ,respectively.The difference between cases with grade 2 and grade 3 was statistically significant (P =0.027).The death rate during follow-up for cases with grade 1,grade 2 and grade 3 were 0,16.7% and 42.9% ,respectively.The difference between cases with grade 1 and grade 3 was statistically significant ( P - 0.001).Univariate analysis showed that grade of stromal invasion (P = 0.001),pathologic stage (P<0.001),presence of lymphovascular permeation (P < 0.001) and lymph node involvement　(P < 0.001) represented important prognostic factors.Multivariate analysis also showed that pathologic stage (P <0.001) was an independent prognostic factor.Conclusions The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors.It represents a useful criterion in prognostic categorization of pTl adenocarcinoma of lung.