胸膜侵犯程度对肺癌手术治疗患者预后的影响

目的研究胸膜侵犯(VPI)程度对肺癌手术治疗患者预后的影响。方法回顾性分析2012年1月至2014年12月上海交通大学附属瑞金医院收治的接受根治性手术切除的100例肺癌患者的临床病例资料,根据VPI程度分为PL0组(n=40)、PL1组(n=38)、PL2组(n=22) 3级。比较不同程度的VPI组患者的临床病理特点,采用COX比例风险模型分析预后的危险因素,采用Kaplan-Meier法进行生存分析,组间比较采用Log-rank检验。结果肺癌手术治疗患者TNM分期、T分期及肿瘤直径、淋巴结转移与VPI程度显著相关(P <0. 05);单因素分析显示,年龄、TNM分期、T分期、肿瘤直径、淋巴结转移、VPI程度与肺癌手术治疗患者的预后相关(P <0. 05);多因素分析显示,年龄、TNM分期、肿瘤直径、VPI程度是肺癌手术治疗患者预后的独立危险因素(P <0. 05)。Kaplan-Meier法进行生存分析显示,患者的平均总生存时间(OS)、无病生存时间(DFS)分别为31. 8个月(95%CI:29. 7~33. 9)、23. 3个月(95%CI:21. 3~25. 4),随着VPI程度的增加,患者OS、DFS均显著缩短(χ~2=52. 61,64. 46,P <0. 05)。结论 VPI程度与肺癌肿瘤TNM分期具有良好的相关性,是导致肺癌手术治疗患者不良预后的重要因素。

Effect of degree of visceral pleural invasion on prognosis of patients undergoing lung cancer surgery

Objective To study the effect of degree of visceral pleural invasion( VPI) on prognosis of patients undergoing lung cancer surgery. Methods Clinical data of 100 patients with lung cancer received radical resection in Ruijin Hospital affiliated to Shanghai Jiaotong University from January 2012 to December 2014 were retrospectively analyzed. According to the degree of VPI,patients were divided into PL0 group( n =40),PL1 group( n = 38) and PL2 group( n = 22). The clinicopathological characteristics of patients among different degrees of VPI was compared,COX proportional risk model was used to analyze the risk factors of prognosis,and Kaplan-Meier was used for survival analysis,Log-rank test was used for comparison within groups. Results TNM stage,T stage,tumor diameter and lymph node metastasis were significantly correlated with VPI degree in lung cancer surgery patients( P < 0. 05). Univariate analysis showed that age,TNM stage,T stage,tumor diameter,VPI degree and lymph node metastasis were correlated with prognosis of patients undergoing lung cancer surgery( P < 0. 05). Multivariate analysis showed that age,TNM stage,tumor diameter and VPI degree were independent risk factors for the prognosis of lung cancer surgery patients( P < 0. 05). The Kaplan-Meier survival analysis showed that the mean overall survival( OS) and disease-free survival time( DFS) of the patients were 31. 8 months( 95% CI: 29. 7 ~ 33. 9) and 23. 3 months( 95% CI: 21. 3 ~ 25. 4),respectively. With the increase of VPI,the patients’ OS and DFS were significantly shortened( χ2= 52. 61,64. 46,P < 0. 05). Conclusion VPI degree has a good correlation with TNM stage of lung cancer,which is an important factor leading to poor prognosis of patients undergoing lung cancer surgery.