早期肺腺癌臨床與病理之分析研究

The Analysis of Clinical and Pathological Correlation with Early Stage Lung Adenocarcinoma

王昱婷(Yu-Ting Wang)

指導教授 ： 陳志毅

中山醫學大學/醫學院/醫學研究所/碩士(2020年)

https://doi.org/10.6834/csmu202000253

摘要

研究目的：
第八版AJCC肺癌分期系統已於2018年廣泛使用。這一新的分期系統採用了新的WHO分類，其中原位腺癌（AIS）和微浸潤腺癌（MIA，侵入性大小≤0.5cm），能夠預期病人將能夠有很高的生存率以及很低的復發率。如果浸潤的大小超過0.5cm，則腫瘤進一步分類為不同的T期。小於3cm的腫瘤，按照浸潤的大小，它們被分類為T1：T1a腫瘤≤1 cm，T1b：腫瘤> 1cm且≤2cm，T1c：腫瘤> 2且≤3cm。大於3 cm的腫瘤被歸類為T2：T2a，腫瘤> 3cm且≤4cm，T2b：腫瘤> 4cm且≤5 cm。我們希望找出在早期（原位腺癌至T2）肺腺癌中，復發率和無復發生存率與這個新的AJCC分期系統之間的相關性。

研究方法及資料：
我們從2014年至2018年的中山醫學大學附設醫院病理記錄中檢索了所有手術切除的肺腺癌，排除已知有復發、轉移以及T3、T4的病人，找出早期肺腺癌患者進行分析。對類別變量進行卡方檢驗和Fisher精確檢驗。採用Kaplan-Meier曲線和Cox回歸模型比較不同期別患者的無惡化存活期。P值小於0.05被認為是有顯著差異。

研究結果：
總共376例外科手術切除的患者符合早期肺腺癌的條件，並被選入本研究。 95.2％的Tis，100％的T1（mi）和77.5％的T1a患者的整體腫瘤大小≤1.0cm。此外，所有Tis，T1（mi）和T1a腫瘤均屬於伏壁型，腺泡型或乳頭型組織學模式。所有處於Tis，T1（mi）和T1a期的患者在3年內均未見腫瘤復發，而處於T1b，T1c，T2a和T2b期的患者在3年內均出現了少量腫瘤復發（p <0.000 ）。

結論與建議：
這是一項根據第8期AJCC癌症分期系統檢查I期和II期患者預後的初步研究，結果表明Tis，T1（mi）和T1a患者的生存率極高。我們建議，當腫瘤僅具有伏壁型，腺泡型或乳頭型組織學模式時，將肺腺癌≤1cm劃分為Tis，T1（mi）或T1a不是必需的。這些腫瘤都可以歸類為T1a，並期望其預後良好。這個建議必須通過更大的研究來證實。

關鍵字

肺腺癌 ； 微浸潤腺癌 ； 原位癌 ； 第8版AJCC ； 家族史 ； 存活率 ； 復發

並列摘要

The 8th Edition of American Joint Committee on Cancer(AJCC) Cancer Staging system for lung cancer has been broadly used since 2018. This new staging system has adopted the new criteria for tumor size, especially Tis, T1(mi), and T1a, which is based on stromal invasion evaluated through microscopic evaluation. It can be quite challenging for lung pathologists.
The pathology reports of all patients with surgically resected pulmonary adenocarcinoma from January 2014 to April 2018 in Chung Shan Medical University Hospital were retrieved for review. Only patients diagnosed with adenocarcinoma in situ, stages I and II were analyzed for their clinical characteristics and survival.
In total, 376 patients with surgical resection were qualified as having early-stage lung adenocarcinoma and were selected for this study. Whole tumor size in 95.2% of Tis, 100% of T1(mi), and 77.5% of T1a patients was ≤1.0 cm. In addition, all of the Tis, T1(mi) and T1a tumors were belonged to lepidic, acinar, or papillary histological patterns. All patients at stages Tis, T1(mi), and T1a had no tumor recurrence within 3 years, while patients of stages T1b, T1c, T2a, and T2b all had a few tumor recurrences within 3 years (p<0.000).
This was a pilot study to examine the prognosis of patients at stages I and II according to the 8th AJCC cancer staging system. The results demonstrated excellent survival for Tis, T1(mi) and T1a patients. We would propose that dividing the lung ADC ≤1 cm into Tis, T1(mi), or T1a is not essential when the tumors only have lepidic, acinar, or papillary histological patterns. These tumors can all be grouped as T1a and expect their prognosis to be good. This proposal must be confirmed by a larger cohort study.

並列關鍵字

lung adenocarcinoma ； Minimaly invasive adenocarcinoma (MIA) ； Adenocarcinoma in situ (AIS) ； 8th Edition of AJCC ； family history ； free survival ； recurrence

參考文獻

1. Ferlay, J., et al., GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. International Agency for Research on Cancer. World Health Organization (WHO) Disponible en: http://www. globocan. iarc. fr [Consultado en enero de 2018], 2018.

2. Alberg, A.J., D.R. Shopland, and K.M. Cummings, The 2014 Surgeon General's report: commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and updating the evidence on the health consequences of cigarette smoking. American journal of epidemiology, 2014. 179(4): p. 403-412.

3. Wang, T.-j., B.-s. Zhou, and J.-p. Shi, Lung cancer in nonsmoking Chinese women: a case-control study. Lung cancer, 1996. 14: p. S93-S98.

4. Ko, Y.-C., et al., Risk factors for primary lung cancer among non-smoking women in Taiwan. International journal of epidemiology, 1997. 26(1): p. 24-31.

5. Ko, Y.-C., et al., Chinese food cooking and lung cancer in women nonsmokers. American journal of epidemiology, 2000. 151(2): p. 140-147.