在临床 T1 非小细胞肺癌患者中，基于实体大小的放射学表现对淋巴结转移和预后的不同影响

IF 4.7 2区医学 Q1 RESPIRATORY SYSTEM

Respiratory Research Pub Date : 2024-02-21 DOI:10.1186/s12931-024-02727-z

Zhihua Li, Cheng Pan, Wenzheng Xu, Chen Zhao, Xianglong Pan, Zhibo Wang, Weibing Wu, Liang Chen

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引用次数: 0

摘要

与部分实性结节（PSN）相比，实性结节（SN）的侵袭性更强，预后更差。本研究旨在根据cT1非小细胞肺癌（NSCLC）实性结节的大小，评估结节放射学外观（SN与PSN）对淋巴结转移和预后的具体影响。回顾性筛选了2010年至2019年期间接受解剖切除术的cT1 NSCLC患者。采用单变量和多变量逻辑回归分析评估结节放射学外观与淋巴结转移之间的关联。预后评估采用对数秩检验和 Cox 回归分析。采用竞争风险模型评估累积复发风险。分别有958名和665名NSCLC患者患有PSN和SN。与PSN组相比，SN组的总体淋巴结转移率更高（21.7% vs. 2.7%，P<0.001），包括N1站（17.7% vs. 2.1%）、N2站（14.0% vs. 1.6%）和跳结转移（3.9% vs. 0.6%）。然而，对于 cT1a NSCLC，SN 和 PSN 之间不存在显著差异（0 vs. 0.4%，P = 1）。此外，不同结节站的结节放射学外观对淋巴结转移的影响也不同。实性 NSCLC 患者的预后比部分实性患者差（5 年无病生存率：79.3% 对 96.2%，P < 0.001）。只有 cT1b 和 cT1c NSCLC 患者的生存率较低，而 cT1a 患者的生存率较低。令人吃惊的是，即使是结节受累的患者，SN的无病生存率（P = 0.048）和累积复发率（P < 0.001）仍低于PSN。具体来说，SN 在每个部位的复发风险都高于 PSN。不过，SN和PSN的复发分布情况相似，只是实性NSCLC的N2淋巴结复发率更高（28.21% vs. 7.69%，P = 0.041）。在cT1b和cT1c NSCLC中，SN比PSN有更高的淋巴结转移风险和更差的预后，但在cT1a中则没有。SN患者N2淋巴结复发的比例高于PSN患者。SN和PSN需要不同的结节评估和术后随访策略。

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Distinct impacts of radiological appearance on lymph node metastasis and prognosis based on solid size in clinical T1 non-small cell lung cancer

Solid nodules (SN) had more aggressive features and a poorer prognosis than part-solid nodules (PSN). This study aimed to evaluate the specific impacts of nodule radiological appearance (SN vs. PSN) on lymph node metastasis and prognosis based on solid size in cT1 non-small cell lung cancer (NSCLC). Patients with cT1 NSCLC who underwent anatomical resection between 2010 and 2019 were retrospectively screened. Univariable and multivariable logistic regression analyses were adopted to evaluate the associations between nodule radiological appearance and lymph node metastasis. The log-rank test and Cox regression analyses were applied for prognostic evaluation. The cumulative recurrence risk was evaluated by the competing risk model. There were 958 and 665 NSCLC patients with PSN and SN. Compared to the PSN group, the SN arm had a higher overall lymph node metastasis rate (21.7% vs. 2.7%, P < 0.001), including nodal metastasis at N1 stations (17.7% vs. 2.1%), N2 stations (14.0% vs. 1.6%), and skip nodal metastasis (3.9% vs. 0.6%). However, for cT1a NSCLC, no significant difference existed between SN and PSN (0 vs. 0.4%, P = 1). In addition, the impacts of nodule radiological appearance on lymph node metastasis varied between nodal stations. Solid NSCLC had an inferior prognosis than part-solid patients (5-year disease-free survival: 79.3% vs. 96.2%, P < 0.001). The survival inferiority only existed for cT1b and cT1c NSCLC, but not for cT1a. Strikingly, even for patients with nodal involvement, SN still had a poorer disease-free survival (P = 0.048) and a higher cumulative incidence of recurrence (P < 0.001) than PSN. Specifically, SN had a higher recurrence risk than PSN at each site. Nevertheless, the distribution of recurrences between SN and PSN was similar, except that N2 lymph node recurrences were more frequent in solid NSCLC (28.21% vs. 7.69%, P = 0.041). SN had higher risks of lymph node metastasis and poorer prognosis than PSN for cT1b and cT1c NSCLC, but not for cT1a. SN exhibited a greater proportion of N2 lymph node recurrence than PSN. SN and PSN needed distinct strategies for nodal evaluation and postoperative follow-up.

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来源期刊

Respiratory Research 医学-呼吸系统

自引率

1.70%

发文量

314

期刊介绍： Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.