Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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A Study of the Prognostic Factors in Resected Stage I Non-Small Cell Lung Cancer

제1병기 비소세포폐암 절제례의 예후인자에 대한 연구

  • 김창수 (고신대학교 의학부 흉부외과학 교실) ;
  • 천수봉 (고신대학교 의학부 흉부외과학 교실) ;
  • 조성래 (고신대학교 의학부 흉부외과학 교실)
  • Published : 1998.10.01
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Abstract

Background: About 30% to 40% of the patients with pathologic stage I non-small cell lung cancer (NSCLC) die within 5 years after complete resection. The identification of poor prognostic factors and the application of additional treatment are very important to improve the survival rate in resected stage I NSCLC. Materials and methods: Sixty-eight(68) patients who had been diagnosed postoperatively between Janury 1989 and December 1995 as having stage I non-small cell lung cancer according to the TNM classification were studied. The postoperative 5-year survival rate was calculated with the Kaplan-Meier method, and clinico- histopathologic factors including age, sex, operative method, type of tumor cell, T factor, grade of the differentiation in a squamous cell carcinoma, invasion of blood vessel and expression of the nm23-H1 protein were investigated and analyzed. Results: The median survival of the entire group of patients was 58$\pm$3 months, with a 5-year survival of 58.9%. In univariate analysis, invasion of blood vessel and poor differentiation of the tumor cell in a squamous cell carcinoma significantly worsened the survival. In multivariate analysis, invasion of blood vessel and grade of the differentiation of the tumor cells in a squamous cell carcinoma remained independent prognostic factors. High expression of the nm23-H1 protein was related to a high postoperative 5-year survival in comparision with low expression of the nm23-H1 pretein (73.0% vs 50.7%), but there was no statistical significance. Conclusions: These results highlight the negative prognostic value of poor differentiation of tumor cells in a squamous cell carcinoma and invasion of blood vessel in stage I non-small cell lung cancer. Also, further studies are necessary to be determined prognostic value of the T factor and expression of the nm23 protein in non-small cell lung cancer.

비소세포폐암의 술후 생존률의 향상을 위하여 1989년 1월부터 1995년 12월까지 고신대학교 복음병원 흉부외과에서 수술시행한 환자중에 술후 제1병기 비소세포폐암으로 진단된 68명의 환자를 대상으로 Kaplan-Meier 방법에 의해 5년 생존률을 구하고 임상 및 병리조직학적인자, 즉 연령, 성별, 수술방법, 조직학적 유형, T인자, 종양세포에 의한 혈관침습 유무, 그리고 전이 억제 유전자로 알려진 nm23 단백의 발현정도와 생존율과의 관계에 대한 분석을 시행하였다. 평균 생존기간은 58$\pm$3개월이었고 5년 생존률은 58.9%였다. 종양에 의한 혈관침습이 있는 경우와 저분화성 편평세포폐암인 경우에 예후가 불량한 것으로 나타났고, T1이 T2에 비해 또 nm23 단백의 발현은 고도발현 군이 저도발현 군에 비해 각각 5년 생존률이 높았으나 통계학적인 유의성은 없었다. T인자, 혈관침습, 편평세포암종에서 분화도, 그리고 nm23 단백의 발현들 상호간에 연관성도 없었다. 제1병기 비소세포폐암의 술후 예후인자는 종양세포에 의한 혈관침습과 편평세포 폐암종에서 종양세포의 분화도로 나타났고, nm23 단백 발현정도의 예후인자로서 역할에 대해서는 nm23 단백 발현 정도와 타 장기로의 전이와의 상관성 등 향후 추가적인 연구가 보완되어야 할 것으로 사료된다.

Keywords

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