尽管内脏胸膜侵犯、淋巴血管侵犯、肿瘤通过气腔扩散以及分化差是与肺腺癌患者不良预后相关的病理危险因素，但这些因素对预后的累积影响仍不清楚。我们入组了1532例I期肺腺癌患者腺癌。根据危险因素的多少将患者分为：A组（无危险因素）、B组（一种危险因素）、C组（多种危险因素）。此外，我们根据肿瘤大小（≤ 3 cm、3-4 cm）将患者分为两个亚组。 Kaplan-Meier 分析用于评估 5 年无病生存 (DFS) 和总生存 (OS)。总体而言，A、B 和 C 组分别包括 949 例、404 例和 179 例患者。 C组肿瘤体积较大，胸外复发病例数也较多。 A 至 C 组的 5 年 DFS 和 OS 逐渐下降（DFS：分别为 94.3%、80.6% 和 64.3%，p< 0.001；OS：分别为 97.2%、92.7% 和 77%，p< 0.001 ）。对于大小≤ 3 cm的肿瘤也观察到类似的趋势（DFS：分别为95.2％、83.2％和68.5％，p< 0.001；OS：分别为97.6％、94.1％和79.6％，p< 0.001），但对于大小在 3 至 4 cm 之间的肿瘤，观察到的趋势不太明显（DFS：分别为 72.1、60.8 和 43.3%，p = 0.054；OS：分别为 85.7、82.1 和 64.7%，p = 0.16）。 I 期肺腺癌患者的术后生存率随着病理危险因素的增加而恶化，尤其是肿瘤大小≤ 3 cm 的患者。© 2024。外科肿瘤学会。

Although visceral pleural invasion, lymphovascular invasion, tumor spread through air spaces, and poor differentiation are pathological risk factors associated with unfavorable prognosis in patients with lung adenocarcinoma, the cumulative impact of these factors on prognosis remains unclear.We enrolled 1532 patients with stage I lung adenocarcinoma. Patients were divided according to the number of risk factors as follows: Group A (without risk factors), Group B (one risk factor), and Group C (multiple risk factors). Moreover, we stratified patients into two subgroups based on tumor size (≤ 3 cm, 3-4 cm). Kaplan-Meier analysis was used to evaluate 5-year disease-free survival (DFS) and overall survival (OS).Overall, 949, 404, and 179 patients were included in Groups A, B, and C, respectively. Group C had a larger tumor size and more cases of extrathoracic recurrence than the other groups. The 5-year DFS and OS gradually decreased across Groups A to C (DFS: 94.3%, 80.6%, and 64.3%, respectively, p < 0.001; OS: 97.2%, 92.7%, and 77%, respectively, p < 0.001). A similar trend was observed for tumors ≤ 3 cm in size (DFS: 95.2%, 83.2%, and 68.5%, respectively, p < 0.001; OS: 97.6%, 94.1%, and 79.6%, respectively, p < 0.001), but a less pronounced trend was observed for tumors between 3 and 4 cm in size (DFS: 72.1, 60.8, and 43.3%, respectively, p = 0.054; OS: 85.7, 82.1, and 64.7%, respectively, p = 0.16).Postoperative survival worsened with increasing pathological risk factors in patients with stage I lung adenocarcinoma, especially those with tumor size ≤ 3 cm.© 2024. Society of Surgical Oncology.