Kang Jeong-Han, Kim Kil Dong, Chung Kyung Young
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Eur J Cardiothorac Surg. 2003 Jun;23(6):865-9. doi: 10.1016/s1010-7940(03)00119-2.
The purpose of this study was to clarify the prognostic significance of visceral pleura invasion in T2 non-small cell lung cancer (NSCLC).
Between 1990 and 2001, 439 consecutive patients with T2 NSCLC underwent curative surgical resection. The subjects included 234 patients with stage IB, 95 with stage IIB, and 110 with stage IIIA and B disease. The patients were divided into two groups according to the existence of visceral pleura invasion (group I without, group II with). Both groups were compared with regard to tumor size, histology, associated mediastinal lymph node involvement, and survival rates.
Visceral pleura invasion (group II) was identified in 114 patients (26%), and was present in 22% of patients with NSCLC with a tumor size of 3 cm or less and in 27% of those with a tumor larger than 3 cm (P=0.37). Visceral pleura invasion was associated with a higher frequency of mediastinal lymph node involvement (group I=22%, group II=34%, P=0.009). Five- and 10-year survival rates were 50 and 45% in group I, and 36 and 22% in group II (P=0.0006). In stage IB, visceral pleura invasion was identified in 53 patients (23%), and 5- and 10-year survival rates were 63 and 60% in the visceral pleura non-invasion group, and 44 and 28% in visceral pleura invasion group (P=0.0018). By multivariate Cox model analysis, age at intervention (relative risk=1.03, P=0.0017), N status (relative risk=1.53, P<0.0001), tumor size (relative risk=1.83, P=0.0452) and visceral pleura invasion (relative risk=1.42, P=0.0291) were independent predictors of poor prognosis.
We were able to demonstrate that visceral pleura invasion was a factor of poor prognosis in T2 NSCLC. It was found to correlate with more extensive mediastinal lymph node involvement and a decreased survival rates. Therefore, the patients with visceral pleura invasion should be closely followed up especially.
本研究旨在阐明脏层胸膜侵犯在T2期非小细胞肺癌（NSCLC）中的预后意义。
1990年至2001年间，439例连续的T2期NSCLC患者接受了根治性手术切除。研究对象包括234例IB期患者、95例IIB期患者以及110例IIIA期和IIIB期患者。根据是否存在脏层胸膜侵犯将患者分为两组（I组无侵犯，II组有侵犯）。比较两组患者的肿瘤大小、组织学类型、相关纵隔淋巴结受累情况及生存率。
114例患者（26%）存在脏层胸膜侵犯（II组），在肿瘤大小为3cm或更小的NSCLC患者中，22%存在脏层胸膜侵犯，在肿瘤大于3cm的患者中，27%存在脏层胸膜侵犯（P = 0.37）。脏层胸膜侵犯与纵隔淋巴结受累频率较高相关（I组=22%，II组=34%，P = 0.009）。I组的5年和10年生存率分别为50%和45%，II组分别为36%和22%（P = 0.0006）。在IB期，53例患者（23%）存在脏层胸膜侵犯，脏层胸膜无侵犯组的5年和10年生存率分别为63%和60%，脏层胸膜侵犯组分别为44%和28%（P = 0.0018）。通过多因素Cox模型分析，干预时年龄（相对风险=1.03，P = 0.0017）、N分期（相对风险=1.53，P<0.0001）、肿瘤大小（相对风险=1.83，P = 0.0452）和脏层胸膜侵犯（相对风险=1.42，P = 0.0291）是预后不良的独立预测因素。
我们能够证明脏层胸膜侵犯是T2期NSCLC预后不良的一个因素。发现它与更广泛的纵隔淋巴结受累及生存率降低相关。因此，对存在脏层胸膜侵犯的患者应尤其密切随访。
