吸烟对原发性肺腺癌患者组织学亚型特征及预后的影响

徐艳; 谭维维; 樊萍; 杨宗泽; 张姝; 席佳蕾; 王亚曦; 胡迅

吸烟对原发性肺腺癌患者组织学亚型特征及预后的影响

Impact of Smoking on the Histological Subtype and Outcome of the Primary Lung Adenocarcinoma

摘要

摘要:
目的探讨在中国肺腺癌患者中，吸烟对组织形态学特征及预后的影响。
方法 266例原发性肺腺癌患者按照2011年肺腺癌国际肺癌研究协会/美国胸科学会/欧洲呼吸学会(International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society, IASLC/ATS/ERS)新分类方法进行组织学亚型重新分类，分析吸烟状况等各种临床病理特征与组织学亚型的关系以及对患者术后生存期的影响。
结果组织学亚型主要为腺泡状为主型(30.1%)、乳头状为主型(26.7%)、实体状为主型(25.9%)、贴壁状为主型(11.7%)。吸烟状况与组织学亚型有关，实体状为主型患者组中，吸烟患者所占比例高于不吸烟患者，而其它亚型组中则均为不吸烟患者所占比例更高(P＜0.05)。Cox比例风险回归模型分析显示，在整体患者中，组织学亚型及TNM分期是术后生存期的预测因子；将患者分为吸烟患者和不吸烟患者，TNM分期在两类患者中均为术后生存期的预测因子，而组织学亚型则只在吸烟患者中显示对预后有显著性影响〔标准偏回归系数(B)=0.898，相对危险度(RR)=2.455〕，与非实体状为主型患者比较，实体状为主患者的预后明显较差。
结论吸烟与实体状为主亚型关联，并进一步对预后造成影响。

Abstract:
Objective To explore the effect of smoking on the histological subtype and prognosis of patients with lung adenocarcinoma (LAC) in China.
Methods According to the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society(IASLC/ATS/ERS)classification, 266 donors with primary LAC were reclassified. The correlation between clinicopathological factors including smoking status and the histological subtype was analyzed, and survival analysis was used to analyze the prognosis of primary LAC.
Results There were four main histological subtypes including acinar predominant adenocarcinoma (APA) 30.1%, papillary predominant adenocarcinoma (PPA) 26.7%, solid predominant adenocarcinoma (SPA) 25.9%, and lepidic predominant adenocarcinoma (LPA) 11.7%.Smoking was associated with the histological subtype.The proportion of smokers was significantly higher than non-smokers in the SPA group, and the proportion of non-smokers was higher in other subtypes group. Cox regression model showed that the histological subtype and TNM stage were the independent predictors of prognostic in all patients.TNM stage was the predictor of postoperative survival in both smokers and non-smokers, and histological subtypes was the predictor only in smokers (β=0.898, RR=2.455). Compared with the non-SPA group, the prognosis of the SPA group was significantly worse.
Conclusion Smoking is associated with SPA subtype, which affect the prognosis of primary LAC.

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