Postoperative significance of horizontal fissure differentiation and the distance from tumor margin to horizontal fissure in patients with invasive non-small cell lung cancer

doi:10.3760/cma.j.cn441417-20240523-05012

Abstract

Abstract:

Objective　To assess the postoperative significance of horizontal fissure differentiation and the distance from tumor margin to horizontal fissure in non-small cell lung cancer (NSCLC). Methods　The clinicopathological data and follow-up results of surgical patients with NSCLC were selected in the Department of Cardiothoracic Surgery of Yantai Laiyang Central Hospital between July 2018 and July 2021. The horizontal fissure differentiation was evaluated by chest enhanced thin slice computed tomography (CT) combined with intraoperative direct vision exploration, including 33 good cases and 58 incomplete cases. The distance from tumor margin to horizontal fissure was measured by chest enhanced thin slice CT in 58 patients with incomplete horizontal fissure differentiation. With 4 cm as the critical distance, 25 cases were ≤4 cm and 33 cases were >4 cm. The patients' general data were collected, including gender, age, smoking, histological type, degree of differentiation, and TNM stage. The patients were followed up for 36 months by telephone follow-up or outpatient review, once every 2 months, and the recurrence (lymph node metastasis, in-situ recurrence, and distant metastasis) and disease-free survival were recorded. χ² test was used for statistical analysis, Kaplan-Meier curve was used for survival analysis, Log-rank test was used for single factor analysis, and COX proportional risk regression model was used for multivariate analysis. Results　There were no statistically significant differences in the general data of NSCLC patients with different horizontal fissure differentiation (all P>0.05). The disease-free survival time was 30.5 months in patients with good horizontal fissure differentiation and 24.6 months in patients with incomplete horizontal fissure differentiation, without statistically significant difference (P>0.05). TNM stage (HR=2.592, 95%CI: 1.739-3.865) and differentiation degree (HR=3.199, 95%CI: 1.711-5.982) were independent risk factors for prognosis of NSCLC patients (both P<0.05). There were no statistically significant differences in the general data of NSCLC patients with incomplete horizontal fissure differentiation with different distances from tumor margin to horizontal fissure (all P>0.05). The disease-free survival time was 29.4 months in patients with distance from tumor margin to horizontal fissure >4 cm, and 18.5 months in patients with distance from tumor margin to horizontal fissure ≤4 cm, with a statistically significant difference (P<0.05). Distance from tumor margin to horizontal fissure (HR=2.381, 95%CI: 1.073-5.287), TNM stage (HR=2.609, 95%CI: 1.566-4.347), and differentiation degree (HR=3.384, 95%CI: 1.539-7.441) were independent risk factors for prognosis of NSCLC patients with incomplete horizontal fissure differentiation (all P<0.05). Conclusion　The distance from tumor margin to horizontal fissure is an independent risk factor for the prognosis of NSCLC patients with incomplete horizontal fissure differentiation, and can be used to evaluate the patients' prognosis and guide comprehensive treatment.

Key words:

Non-small cell lung cancer, Incomplete horizontal fissure differentiation, Distance from tumor margin to horizontal fissure, Prognosis

摘要：

目的　探讨非小细胞肺癌患者水平裂分化情况及肿瘤边缘-水平裂距离与预后的关系。方法　选取2018年7月至2021年7月在烟台市莱阳中心医院胸心外科接受胸腔镜肺叶切除术的91例非小细胞肺癌患者作为研究对象。采用胸部增强薄层电子计算机断层扫描（CT）联合术中直视探查评估患者水平裂分化情况，良好33例，不全58例。采用胸部增强薄层CT测量58例水平裂分化不全患者肿瘤边缘-水平裂距离，以4 cm为距离临界值，≤4 cm 25例，>4 cm 33例。收集患者一般资料，包括性别、年龄、吸烟、组织学类型、分化程度、TNM分期；术后采用电话回访或门诊复查等随访36个月，每2个月随访1次，记录患者复发情况（淋巴结转移、原位复发及远处转移）和无病生存期。采用χ²检验进行统计学分析；生存分析采用Kaplan-Meier曲线；单因素分析采用Log-rank检验；多因素分析采用COX比例风险回归模型。结果　不同水平裂分化情况非小细胞肺癌患者一般资料比较，差异均无统计学意义（均P>0.05）；水平裂分化良好患者无病生存期为30.5个月，不全患者为24.6个月，二者比较，差异无统计学意义（P>0.05）。TNM分期（HR=2.592，95%CI：1.739～3.865）和分化程度（HR=3.199，95%CI：1.711～5.982）均是非小细胞肺癌患者预后的独立危险因素（均P<0.05）。不同肿瘤边缘-水平裂距离的水平裂分化不全非小细胞肺癌患者一般资料比较，差异均无统计学意义（均P>0.05）；肿瘤边缘-水平裂距离>4 cm患者无病生存期为29.4个月，≤4 cm患者为18.5个月，二者比较，差异有统计学意义（P<0.05）；肿瘤边缘-水平裂距离（HR=2.381，95%CI：1.073～5.287）、TNM分期（HR=2.609，95%CI：1.566～4.347）和分化程度（HR=3.384，95%CI：1.539～7.441）均是水平裂分化不全非小细胞肺癌患者预后的独立危险因素（均P<0.05）。结论　肿瘤边缘-水平裂距离是水平裂分化不全非小细胞肺癌患者预后的独立危险因素，可评估患者预后，指导综合治疗。

关键词:

非小细胞肺癌, 水平裂分化不全, 肿瘤边缘-水平裂距离, 预后

Zhao Jinpeng, Gao Chengfei, Lyu Xiaodong.

Postoperative significance of horizontal fissure differentiation and the distance from tumor margin to horizontal fissure in patients with invasive non-small cell lung cancer [J]. International Medicine and Health Guidance News, 2025, 31(5): 761-765.

赵金鹏高呈飞吕晓东.

浸润性非小细胞肺癌患者水平裂分化情况及肿瘤边缘-水平裂距离与预后的关系 [J]. 国际医药卫生导报, 2025, 31(5): 761-765.

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