Satoh Yukitoshi, Ishikawa Yuichi, Inamura Kentaro, Okumura Sakae, Nakagawa Ken, Tsuchiya Eiju
Department of Pathology, The Cancer Institute, The Japanese Foundation for Cancer Research, Koto-ku, Tokyo 135-8550, Japan.
Virchows Arch. 2005 Dec;447(6):984-9. doi: 10.1007/s00428-005-0031-2. Epub 2005 Sep 21.
Parietal pleural invasion of non-small cell lung cancer (NSCLC) is a factor for poor prognosis, and a tumor of any size that invades the parietal pleura is classified as T3. However, with microscopic invasion beyond elastic fibers of the visceral pleura but no penetration to the parietal pleura at tight adhesion sites (we term this p1-3), classification as to the T factor is unclear. Among 1,179 consecutive patients with NSCLCs who underwent curative surgery between 1980 and 2002, 20 were in this category. Here, a comparison was made with subgroups of p stages IB, II, and IIIA with regard to histology, pleural invasion, and survival rates. To maximize the power of assessing prognostic potential, we set the significance level at 0.10, one-sided. The p1-3 condition sites of the 20 cases were the parietal pleura for 17 cases and the pericardium, diaphragm, and chest wall for one each of the remainder. The 5-year survival rate for these p1-3 patients was 71.6%. Significant differences were observed between p1-3 and IIIA groups. Although the 5-year survival rates did not significantly differ between p1-3 and T3N0 or unequivocal T3 subgroups, the prognosis of p1-3 patients was rather better than that of T3 and identical to T2. It was demonstrated that p1-3 status is not a factor warranting T3 classification for NSCLCs. Considering the prognosis, pathologic p1-3 tumors should be managed as a T2 disease for the present.
非小细胞肺癌（NSCLC）侵犯脏层胸膜是预后不良的一个因素，任何大小的肿瘤侵犯脏层胸膜均被分类为T3。然而，对于显微镜下侵犯超过脏层胸膜弹性纤维但在紧密粘连部位未穿透至壁层胸膜的情况（我们将此称为p1-3），T分期的分类尚不清楚。在1980年至2002年间接受根治性手术的1179例连续NSCLC患者中，有20例属于这一类别。在此，就组织学、胸膜侵犯和生存率方面，将其与p分期为IB、II和IIIA的亚组进行了比较。为了最大限度地提高评估预后潜力的效能，我们将显著性水平设定为单侧0.10。这20例患者的p1-3情况部位，17例为壁层胸膜，其余各1例为心包、膈肌和胸壁。这些p1-3患者的5年生存率为71.6%。观察到p1-3组与IIIA组之间存在显著差异。虽然p1-3组与T3N0或明确的T3亚组之间的5年生存率没有显著差异，但p1-3患者的预后比T3患者要好，且与T2患者相同。结果表明，p1-3状态并非NSCLC进行T3分类的一个依据。考虑到预后，目前病理p1-3肿瘤应作为T2疾病进行处理。
