肺腺癌TNM分期的T因子评估可不考虑磨玻璃影

腺癌的放射学磨玻璃影（ground glass opacity ，GGO)病理上反映出非侵入性原位腺癌（adenocarcinoma in situ ，AIS)。测量肿瘤的直径若包含GGO，也许会过高的评估ＴＮＭ分期T因子。东京大学的Murakawa T等人回顾性分析并评估了GGO对腺癌复发的影响.（Eur J Cardiothorac Surg. 2012 Oct 9. ）

他们评估了于1999年到2009年间经历了外科切除肺腺癌且病理上分期是T1-2N0M0的患者。进行了四种不同的分析（多变量分析，受试者工作特征[receiver operating characteristic ，ROC]分析，亚组生存分析，倾向指数配对的生存分析）去评估GGO和实体成分对复发的影响。

这项研究包括241位患者，其中有34位出现复发。AIS 和微浸润腺癌的68个案例达到100%的无复发生存率。单变量和多变量的分析显示，纵隔窗测量到的最大肿瘤直径是比肺窗测量值更准确的预后因素。这项发现得到ROC曲线分析，亚组分析和倾向指数配对分析的支持。ROC曲线分析显示，评估T时排除GGO组份，能更好地预测复发和病理性脉管侵润情况的预后。亚组分析和倾向指数配对分析的结果表明，实体成分大小一致而GGO大小不同的肿瘤具有相同的无复发生存率。

研究表明，GGO组份对复发影响很小。无复发生存率仅取决于实体成分的大小。因此，只测量实体成分的T因子（TNM分期），也许会更加准确的反映预后。

原文摘要：

The ground glass opacity component can be eliminated from the T-factor assessment of lung adenocarcinoma??

AbstractOBJECTIVES The radiological ground glass opacity (GGO) component of an adenocarcinoma pathologically reflects a non-invasive adenocarcinoma in situ(AIS).Measuring the tumour diameter to include the GGO component may overestimate the T factor.In this retrospective study, we evaluated the effect of the GGO component on the recurrence of an adenocarcinoma.

METHODS We reviewed patients who underwent a surgical resection of a lung adenocarcinoma and were pathologically proven to beT1-2N0M0, from 1999 to 2009. We conducted four different types of analyses (multivariate analysis, receiver operating characteristic [ROC] analysis, survival analysis according to subcategories and survival analysis of propensity score-matched pairs) to evaluate the impacts of GGO and the solid component on recurrence.

RESULTS The study included 241 patients, and there were 34 recurrences. Sixty-eight cases with AIS and minimally invasive adenocarcinoma exhibited 100% recurrence-free survival. A univariate and a multivariate analysis revealed that the maximum tumour diameter measured in the mediastinal window was a better prognostic factor than the maximum tumour diameter in the lung window. This finding was supported by an ROC curve analysis, a subgroup analysis and a propensity score-matched analysis. An ROC curve analysis revealed that GGO component exclusion resulted in improved prognostic performance for recurrence and pathological vessel invasion.A subgroup analysis and a propensity score-matched analysis demonstrated that tumours with similar solid component sizes and different GGO sizes exhibited equivalent recurrence-free survival.

CONCLUSIONS The GGO component showed little influence on recurrence.Recurrence-free survival was solely dependent on the solid component size. A T factor measured by the solid component may be a more accurate prognostic parameter.

Links:http://ejcts.oxfordjournals.org/content/early/2012/10/09/ejcts.ezs467.short?rss=1