Magdeleinat P, Alifano M, Benbrahem C, Spaggiari L, Porrello C, Puyo P, Levasseur P, Regnard J F
Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital, Paris, France.
Ann Thorac Surg. 2001 Apr;71(4):1094-9. doi: 10.1016/s0003-4975(00)02666-7.
The study was performed to assess prognostic factors in patients with lung cancer invading the chest wall treated by surgery.
We reviewed retrospectively clinical records of all patients operated on for lung cancer invading chest wall structures between 1984 and 1998.
Two hundred one patients were operated on in this 14-year period. One hundred thirty-seven lobectomies, 55 pneumonectomies, and 9 wedge resections were performed. Extrapleural resection (when invasion was limited to the parietal pleura) and chest wall resection (in the case of invasion of deeper structures) were combined with pulmonary resection in 79 (39%) and 122 (61%) cases, respectively. Pathologic TNM stages were T3N0 in 116 (57.5%) cases, T3N1 in 52 (26%), T3N2 in 27 (13.5%), and T4N0-N1 in 6 (3%). A complete resection was achieved in 167 (83%) cases. Fourteen postoperative deaths (7%) occurred. One hundred thirty-nine patients (74%) underwent postoperative radiotherapy. Actuarial 5-year survival was 24% and 13% after complete and incomplete resection, respectively (p < 0.05). Actuarial 5-year survival after complete resection was 25% in T3N0 patients, 20% in T3N1, and 21% in T3N2. In completely resected patients, univariate and multivariate analyses identified three independent prognostic factors: nodal involvement, depth of parietal invasion, and age. Radiation therapy did not improve survival if a complete resection was possible.
Completeness of resection, nodal involvement, depth of invasion, and age affect survival of patients with lung cancer invading the chest wall. N2 disease should not be considered a contraindication to surgery.
本研究旨在评估接受手术治疗的侵犯胸壁的肺癌患者的预后因素。
我们回顾性分析了1984年至1998年间所有因肺癌侵犯胸壁结构而接受手术的患者的临床记录。
在这14年期间，共有201例患者接受了手术。其中137例行肺叶切除术，55例行全肺切除术，9例行楔形切除术。当侵犯仅限于壁层胸膜时行胸膜外切除术，侵犯更深层结构时行胸壁切除术，分别有79例（39%）和122例（61%）与肺切除术联合进行。病理TNM分期为T3N0的有116例（57.5%），T3N1的有52例（26%），T3N2的有27例（13.5%），T4N0-N1的有6例（3%）。167例（83%）实现了完全切除。术后死亡14例（7%）。139例（74%）患者接受了术后放疗。完全切除和不完全切除后的5年精算生存率分别为24%和13%（p<0.05）。T3N0患者完全切除后的5年精算生存率为25%，T3N1为20%，T3N2为21%。在完全切除的患者中，单因素和多因素分析确定了三个独立的预后因素：淋巴结受累、壁层侵犯深度和年龄。如果可以完全切除，放疗并不能提高生存率。
切除的完整性、淋巴结受累、侵犯深度和年龄影响侵犯胸壁的肺癌患者的生存。N2期疾病不应被视为手术禁忌证。
