目的：研究T1期浸润性肺腺癌5种常见病理亚型的临床病理特征及其对预后的影响,为肺腺癌临床监测及治疗提供参考。方法：纳入上海交通大学医学院附属瑞金医院2009年1月至2011年1月间行肺癌手术,且术后经病理检查证实为浸润性肺腺癌、肿瘤直径≤3 cm的患者,分别选取贴壁状为主型、腺泡为主型、乳头状为主型、微乳头状为主型、实性为主型各24例,5组共计120例。对患者的临床病理资料包括年龄、性别、癌胚抗原（carcinoembryonic antigen,CEA）水平、肿瘤分化程度、病理亚型等进行回顾性分析,应用Kaplan-Meier法计算生存率,Log-Rank检验比较生存差异;多因素COX回归分析判定预后的危险因素。结果：5组不同病理亚型肺腺癌患者的年龄、性别、癌胚抗原（carcinoembryonic antigen, CEA）水平、肿瘤细胞分化程度差异均无统计学意义（P>0.05）,而5组间的胸膜浸润、有无淋巴结转移、术后TNM分期及术后有无复发进展情况差异有统计学意义（P<0.05）。5种肺腺癌亚型中,微乳头状为主型的淋巴结转移率（62.5%）和术后复发转移率（41.6%）最高。进一步行生存率分析显示,贴壁状为主型患者的预后最好,5年生存率为96.0%,微乳头状为主型患者预后最差,5年生存率为66.7%,2组间差异有统计学意义（P<0.05）。病理亚型、淋巴结转移情况、术后TNM分期是影响T1期浸润性肺腺癌患者预后的危险因素,且病理亚型、淋巴结转移情况还是影响其预后的独立危险因素（OR均>1）。结论：T1期浸润性肺腺癌患者的预后与其病理亚型有关,而其中微乳头状为主亚型患者有着较高的淋巴转移率和更差的预后,对于该亚型的T1期浸润性肺腺癌患者,在术后可能需采取更积极的治疗和严密观察。
Objective: To study the clinicopathological features and prognostic significance of different pathological subtypes of T1 invasive lung adenocarcinoma for providing a reference for the monitoring and treatment strategy of lung adenocarcinoma. Methods: A total of 120 patients undergone surgical treatment and confirmed by postoperative pathology as invasive lung adenocarcinoma with tumor diameter less than or equal to 3 cm from Jan. 2009 to Jan, 2011 were enrolled. The patients were divided into five groups according to dominant pathological subtypes: lepidic group,acinar group, papillary group, micro-papillary group, and solid group. The clinical and pathological data of the patients were analyzed retrospectively. Kaplan-Meier method was used to calculate survival rate. Log-Rank test was used to compare survival difference. COX regression analysis was used to determine the risk factors of prognosis. Result: There were no significant differences in age, sex, CEA level and tumor differentiation between the five groups（P>0.05）. Meanwhile, there were significant differences in invasion of visceral pleura, lymph node metastasis, TNM stage and recurrence or metastasis after operation between the five groups（P<0.05）. Among the five subtypes, lymph node metastasis rate (62.5%) and postoperative recurrence rate (41.6%) were the highest in micro-papillary group. Survival analysis showed that lipidic group had the best prognosis, the 5 year survival rate was 96.0%; the prognosis of micro-papillary group was the worst, and the 5 year survival rate was 66.7%. The difference was statistically significant（P<0.05）. Pathological subtypes, lymph node metastasis and TNM staging were the risk factors influencing the prognosis of stage T1 invasive lung adenocarcinoma. Different pathological subtypes and lymph node metastasis were the independent prognostic factors (OR>1). Conclusions: The prognosis of T1 invasive adenocarcinoma of lung is related to pathological subtype and lymph node metastasis. Micro-papillary subtypes indicate higher lymph node metastasis and poor prognosis. More aggressive treatment and observation might be needed after operation of micro-papillary subtype of invasive lung adenocarcinoma.
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