磨玻璃为主型肺腺癌患者病理结果及预后分析：检出后手术与随访监测后手术患者比较

许金环; 李文平; 张鹏举; 王玮; 武丽俊; 赵绍宏

doi:10.12435/j.issn.2095-5227.2023.024

磨玻璃为主型肺腺癌患者病理结果及预后分析：检出后手术与随访监测后手术患者比较

Pathology results and prognosis in patients with ground glass opacity-predominant lung adenocarcinoma: immediate surgery versus surgery after surveillance

摘要

摘要:
背景随着影像技术的进步，越来越多的肺部磨玻璃结节(ground glass nodule，GGN)被检出，GGN的处理仍是困扰临床的难题。
目的通过分析磨玻璃为主型肺腺癌检出后手术和随访观察≥1年后手术的病理及预后，探讨磨玻璃为主型肺腺癌随访观察的可行性。
方法纳入2013年1月 - 2017年8月在解放军总医院第一医学中心手术切除的磨玻璃为主型肺腺癌病例，包括纯磨玻璃结节(pure GGN，pGGN)和实性肿瘤比(consolidation-to-tumor ratio，CTR)≤0.5的混合磨玻璃结节(mixed GGN，mGGN)，将患者分为检出后手术组(surgery after detection group，SD组)和随访观察≥1年后手术组(surgery after more than or equal to one year surveillance group，SS组)。SS组又分为增长组和未增长组。采用倾向性评分匹配法(propensity score matching，PSM)平衡混杂变量。随访于2022年8月31日截止。比较SD组与SS组的病理结果和预后。
结果在纳入的284个GGN中，SD组214个GGN，SS组70个GGN。经倾向性评分匹配后共120例患者(SD组和SS组各60例)纳入分析。PSM后，SD组与SS组病理结果差异无统计学意义(病理类型：P=0.523；病理亚型：P=0.290)；两组均未见淋巴结转移；两组5年总生存率和无复发生存率均为100%。增长组与未增长组病理结果差异无统计学意义(病理类型：P=0.176；病理亚型：P=0.858)。
结论 SD组与SS组病理结果相似，预后相当，随访可能是磨玻璃为主型肺腺癌可行的管理方法。

Abstract:
Background Advances in imaging technology have led to the detection of more ground glass nodule (GGN) in lung. However, the management of GGN remains controversial.
Objective To analyze the pathology results and prognosis of ground glass opacity-predominant lung adenocarcinoma in patients undergoing surgery after detection and in patients undergoing surgery after more than or equal to one year surveillance, and investigate the feasibility of surveillance for ground glass opacity-predominant lung adenocarcinoma.
Methods From January 2013 to August 2017, patients undergoing surgery for ground glass opacity-predominant lung adenocarcinoma including pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR)≤0.5 in the First Medical Center of Chinese PLA General Hospital were selected. The patients were divided into surgery after detection group (SD group) and surgery after more than or equal to one year surveillance group (SS group), and the SS group was further divided into growth group and non-growth group. Propensity score matching (PSM) was used to adjust for confounding variables. The follow-up ended on August 31, 2022. Pathological outcomes and prognosis were compared between the SD group and the SS group.
Results A total of 284 GGN were included, 214 GGN were in the SD group and 70 GGN in the SS group. Another 120 patients (60 cases in the SD group and 60 cases in the SS group) were included after the propensity score matching. After PSM, there were no significant differences in pathological type and pathological subtype between the SD group and the SS group (P=0.523; P=0.290, respectively). No lymph node metastasis was found in either group. The 5-year OS and 5-year RFS were 100% in both groups. There were no significant differences in pathological type (P=0.176) and pathological subtype(P=0.858) between the growth group and the non-growth group.
Conclusion The pathological results and prognosis of the SD group and the SS group are similar. Active surveillance may be a feasible management approach for ground glass opacity-predominant lung adenocarcinoma.

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