诊断时症状与接受手术治疗I期非小细胞肺癌患者预后的关联：一项前瞻性维护登记处的回顾性队列分析
Association of symptoms at diagnosis with prognosis in patients with surgically treated stage I non-small cell lung cancer: a retrospective cohort analysis of a prospectively maintained registry.
作者
作者单位
- Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, China.
摘要
中文
尽管大多数I期非小细胞肺癌（NSCLC）患者是在早期且可能可治愈的阶段被发现的，但在根治性切除后仍然会发生术后复发和死亡。诊断时出现的症状是否能提供额外的预后信息以对手术治疗I期NSCLC进行风险分层仍不清楚。本研究评估了病理确诊I期NSCLC患者诊断时症状与长期结局之间的关联。这项回顾性队列研究使用了四川大学华西医院在西部肺癌数据库中保存的前瞻性维护的机构注册数据。纳入了2011年至2021年间接受根治性手术切除的病理确诊IA-IB期NSCLC患者。排除了接受非手术主要治疗、非根治性切除或缺乏详细生存或治疗信息的患者。从诊断时的电子病历中提取就诊症状。收集了基线人口统计学、临床、手术和病理协变量。通过门诊就诊、医院病历审查和电话访谈进行随访。使用Cox回归模型评估与总生存期（OS）和无病生存期（DFS）的关联。共纳入9,205名患者，其中2,657名（28.9%）在诊断时有症状。最常见的症状是咳嗽、胸痛和血性痰。有症状的患者更可能是年龄较大、男性、吸烟者，并患有慢性阻塞性肺疾病（COPD）或鳞状细胞癌组织学。症状存在与较差的OS [调整后风险比（HR）=1.22，95%置信区间（CI）：1.01-1.47；P=0.03]和DFS（调整后HR=1.27，95% CI：1.09-1.47；P=0.002）独立相关。在个体症状中，血性痰在调整人口统计学、临床、手术和病理协变量后仍然与较差的OS（调整后HR=1.71，95% CI：1.31-2.24；P<0.001）和DFS（调整后HR=1.71，95% CI：1.36-2.14；P<0.001）独立相关。在手术治疗I期NSCLC患者中，诊断时的就诊症状，特别是血性痰，与较差的长期结局相关。症状状态可能为术后风险分层提供简单的临床线索，并可能有助于识别在根治性切除后需要更密切监测的患者。
English
Although most patients with stage I non-small cell lung cancer (NSCLC) are detected at an early and potentially curable stage, postoperative recurrence and mortality still occur after curative resection. Whether presenting symptoms at diagnosis provide additional prognostic information for risk stratification in surgically treated stage I NSCLC remains unclear. This study evaluated the association between symptoms at diagnosis and long-term outcomes in patients with pathologically confirmed stage I NSCLC. This retrospective cohort study used single-institution data from West China Hospital, Sichuan University, within the Western China Lung Cancer Database, a prospectively maintained institutional registry. Patients with pathologically confirmed stage IA-IB NSCLC who underwent curative-intent surgical resection between 2011 and 2021 were included. Patients receiving non-surgical primary treatment, undergoing non-curative resection, or lacking detailed survival or treatment information were excluded. Presenting symptoms were extracted from electronic medical records at diagnosis. Baseline demographic, clinical, surgical, and pathological covariates were collected. Follow-up was conducted through outpatient visits, hospital record review, and telephone interviews. Cox regression models were used to evaluate associations with overall survival (OS) and disease-free survival (DFS). A total of 9,205 patients were included, of whom 2,657 (28.9%) were symptomatic at diagnosis. The most common symptoms were cough, chest pain, and blood-tinged sputum. Symptomatic patients were more likely to be older, male, smokers, and to have chronic obstructive pulmonary disease (COPD) or squamous cell carcinoma histology. Symptom presence was independently associated with poorer OS [adjusted hazard ratio (HR) =1.22, 95% confidence interval (CI): 1.01-1.47; P=0.03] and DFS (adjusted HR =1.27, 95% CI: 1.09-1.47; P=0.002). Among individual symptoms, blood-tinged sputum remained independently associated with worse OS (adjusted HR =1.71, 95% CI: 1.31-2.24; P<0.001) and DFS (adjusted HR =1.71, 95% CI: 1.36-2.14; P<0.001) after adjustment for demographic, clinical, surgical, and pathological covariates. Presenting symptoms at diagnosis, particularly blood-tinged sputum, was associated with poorer long-term outcomes in patients with surgically treated stage I NSCLC. Symptom status may provide a simple clinical cue for postoperative risk stratification and may help identify patients who require closer surveillance after curative resection.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q2
- 影响因子
- 3.4
- 新锐分区
- 3区