术前CT图像上的纤维化间质肺异常预测I期非小细胞肺癌切除后的病因特异性死亡率
Fibrotic Interstitial Lung Abnormalities on Preoperative CT Images Predict Cause-Specific Mortality after Stage I Non-Small Cell Lung Cancer Resection.
作者
作者单位
- Department of Thoracic Surgery, Kyushu University Hospital, Fukuoka, Japan. akamine.t.surg@gmail.com.
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Japan.
- Department of Thoracic Surgery, Kyushu University Hospital, Fukuoka, Japan.
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
摘要
中文
间质性肺异常（ILA）和临床前间质性肺病（ILD）与肺癌发病率增加和高死亡率相关。然而，它们对临床I期非小细胞肺癌（NSCLC）手术切除后病因特异性死亡率的影响仍不清楚。我们评估了接受手术切除的临床I期NSCLC患者术前ILA与术后死亡率之间的关系。在这项回顾性研究中，我们纳入了2006年至2018年间接受临床I期NSCLC完全切除的患者，并排除了ILD患者。术前计算机断层扫描（CT）图像被分类为无ILA、非纤维化ILA或纤维化ILA。在纳入的704名患者中，75名（10.6%）有ILA，其中24名（3.4%）为非纤维化ILA，51名（7.2%）为纤维化ILA。纤维化ILA患者年龄较大（中位年龄75岁），且主要为男性（88.2%），而629名无ILA患者（中位年龄69岁；男性49.1%）。无ILA、非纤维化ILA和纤维化ILA患者的5年总生存率分别为90.0%、71.0%和35.1%（log-rank p < 0.001）。与无ILA相比，纤维化ILA与较差的总生存率（风险比[HR] 4.50；95%置信区间[CI] 2.86-7.09）和更高的死亡率（肺癌特异性：HR 7.64；95% CI 4.03-14.46；其他原因：HR 2.79；95% CI 1.44-5.42）独立相关。纤维化ILA与I期NSCLC切除后肺癌特异性和其他原因死亡率增加相关，表明纤维化ILA尽管在常规CT上通常细微，但可能作为有临床意义的影像学预后标志物。
English
Interstitial lung abnormalities (ILAs) and preclinical interstitial lung disease (ILD) are associated with an increased incidence of lung cancer and high mortality. However, their impact on cause-specific mortality following surgical resection of clinical stage I non-small-cell lung cancer (NSCLC) remains unclear. We evaluated the relationship between preoperative ILAs and postoperative mortality in patients with clinical stage I NSCLC who underwent surgical resection. In this retrospective study, we included patients who underwent complete resection for clinical stage I NSCLC between 2006 and 2018 and excluded those with ILD. Preoperative computed tomography (CT) images were classified as no ILA, non-fibrotic ILA, or fibrotic ILA. Of the 704 included patients, 75 (10.6%) had ILAs, including 24 (3.4%) with non-fibrotic ILA and 51 (7.2%) with fibrotic ILA. Patients with fibrotic ILAs were older (median age, 75 years) and predominantly male (88.2%), whereas 629 patients had no ILA (median age, 69 years; male, 49.1%). The 5-year overall survival rates were 90.0%, 71.0%, and 35.1% in patients with no, non-fibrotic, and fibrotic ILAs, respectively (log-rank p < 0.001). Fibrotic ILAs were independently associated with poorer overall survival (hazard ratio [HR] 4.50; 95% confidence interval [CI] 2.86-7.09) and higher mortality (lung cancer-specific: HR 7.64; 95% CI 4.03-14.46; other cause: HR 2.79; 95% CI 1.44-5.42) than no ILAs. Fibrotic ILAs were associated with increased lung cancer-specific and other-cause mortality after resection for stage I NSCLC, suggesting that fibrotic ILAs, although often subtle on routine CT, may serve as clinically meaningful imaging prognostic markers.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 3.8
- 新锐分区
- 2区