I期高实性占比及实性肺腺癌患者诊断–手术时间间隔对患者预后的影响

The Effect of Diagnosis-Surgery Interval on the Prognosis of Patients with High Solid Proportion or Solid Stage I Lung Adenocarcinoma

摘要: 目的：探究诊断–手术时间间隔对I期部分实性或实性密度结节肺腺癌患者预后的影响，并分析其与术后病理高危因素之间的关系。方法：通过回顾性分析2018年6月至2019年6月I期肺腺癌患者的临床数据，采用RCS方法探究手术间隔时间与生存结果之间的关系，以RCS图线中拐点为分界，将患者分为A组(n = 293)与B组(n = 234)，采用Kaplan-Meier法绘制生存曲线评估二组差异，采用倾向性得分匹配后控制变量后重复Kaplan-Meier法绘制生存曲线。通过Wilcoxon秩和检验评估两组手术时间、住院时间及带管时间是否存在差异。采用Logistic回归分析，探讨诊断–手术时间间隔与病理高危因素之间的关联性。结果：共收集527例临床诊断为I期的肺腺癌患者，RCS图示拐点为8周，患者复发风险8周后都随诊断–手术时间间隔的延长而增加。诊断时间间隔与DFS行单因素COX分析得，二者之间存在相关(HR, 1.57, 95% CI, 0.95~2.59, P = 0.076)。倾向性得分匹配后可见A组无病生存期及总生存期都强于B组，且存在统计学意义。诊断–手术间隔时间延长会导致脉管癌栓出现的可能性增加(OR 2.35, 95% CI, 1.01~5.47, P = 0.048)，对胸膜侵犯(OR, 1.226, 95% CI, 0.485~3.099, P = 0.667)及气道播散(OR, 1.247, 95% CI, 0.631~2.465, P = 0.526)的出现与否的影响无统计学意义。结论：诊断–手术时间间隔超过8周会导致患者远期预后不良。诊断–手术间隔的延长可能会导致脉管癌栓出现，从而影响患者远期预后。

Abstract: Objective: To investigate the impact of the diagnosis-to-surgery interval (DSI) on the prognosis of patients with stage I lung adenocarcinoma presenting as part-solid or solid density nodules and analyze its association with postoperative pathological high-risk factors. Methods: By retrospectively analyzing the clinical data of stage I lung adenocarcinoma patients from June 2018 to June 2019, the relationship between the surgery interval and survival outcomes was investigated using the RCS method. Patients were divided into group A (n = 293) and group B (n = 234) based on the inflection point in the RCS graph. Survival curves were plotted using the Kaplan-Meier method to assess the differences between the two groups. The Kaplan-Meier method was repeated after propensity score matching to control for variables. The Wilcoxon rank sum test was used to evaluate whether there were differences in the operation time, hospital stay, and tube retention time between the two groups. Logistic regression analysis was used to explore the association between the diagnosis-surgery interval and pathological high-risk factors. Results: A total of 527 patients with stage I lung adenocarcinoma were collected. The inflection point in the RCS graph was 8 weeks, and the recurrence risk increased with the extension of the diagnosis-surgery interval after 8 weeks. Univariate COX analysis of the diagnosis-surgery interval and disease-free survival showed a correlation between the two (HR, 1.57, 95% CI, 0.95~2.59, P = 0.076). After propensity score matching, it was observed that the disease-free survival and overall survival of group A were better than those of group B. An extended diagnosis-surgery interval increased the possibility of vascular tumor thrombus (OR 2.35, 95% CI, 1.01~5.47, P = 0.048), but had no statistically significant impact on the occurrence of pleural invasion(OR, 1.226, 95% CI, 0.485~3.099, P = 0.667) or airway dissemination (OR, 1.247, 95% CI, 0.631~2.465, P = 0.526). Conclusion: A diagnosis-surgery interval exceeding 8 weeks may lead to poor long-term prognosis in patients. An extended diagnosis-surgery interval may increase the occurrence of vascular tumor thrombus, which may be the reason for the poor long-term prognosis of patients.