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肺癌侵犯胸壁:主张整块切除,但需要新的治疗策略。

Lung cancer invading the chest wall: a plea for en-bloc resection but the need for new treatment strategies.

作者信息

Doddoli Christophe, D'Journo Benoit, Le Pimpec-Barthes Françoise, Dujon Antoine, Foucault Christophe, Thomas Pascal, Riquet Marc

机构信息

Department of Thoracic Surgery, Hôpital Sainte-Marguerite, Marseille, France.

出版信息

Ann Thorac Surg. 2005 Dec;80(6):2032-40. doi: 10.1016/j.athoracsur.2005.03.088.

Abstract

BACKGROUND

Factors influencing survival of patients with a nonsmall-cell lung cancer (NSCLC) invading the parietal pleura or the chest wall are still controversial. The aim of this study was to assess prognostic factors in completely resected pT3 chest wall NSCLC patients.

METHODS

We retrospectively reviewed a three-center experience between 1984 and 2002 with 309 patients.

RESULTS

There were 269 male and 40 female patients. Pulmonary resections consisted of 13 wedge resections or segmentectomies, 211 lobectomies, 6 bilobectomies, and 79 pneumonectomies. One hundred patients underwent extrapleural mobilization, and 209, en-bloc resection. Tumors were staged as stages IIB (n = 212) and IIIA (n = 97). Overall 5-year survival rates were 40% and 12% for stage IIB and IIIA, respectively (p < 10(4)). Multivariate analysis shows male sex and bigger tumor size as independent indicators of poor prognosis in stage IIB patients. In stage IIB patients with a chest wall invasion limited to the parietal pleura, en-bloc resections provided higher 5-year survival rates when compared with extrapleural resections (60.3% versus 39.1%; p = 0.03). In stage IIIA patients, multivariate analysis disclosed two independent prognostic factors: the number of resected ribs and adjuvant parietal and mediastinal radiotherapy.

CONCLUSIONS

The presence of lymph node metastases has a disastrous impact on survival in this subset of patients. En-bloc resection is strongly suggested to be the standard of surgical care, and adjuvant radiotherapy does not seem to be necessary in N0 patients when a complete R0 resection has been achieved. For huge tumors (larger than 6 cm), this report suggests that the role of perioperative chemotherapy needs further evaluation.

摘要

背景

影响非小细胞肺癌(NSCLC)侵犯脏层胸膜或胸壁患者生存的因素仍存在争议。本研究旨在评估完全切除的pT3胸壁NSCLC患者的预后因素。

方法

我们回顾性分析了1984年至2002年间三个中心的309例患者的情况。

结果

男性患者269例,女性患者40例。肺切除术包括13例楔形切除术或肺段切除术、211例肺叶切除术、6例双叶切除术和79例全肺切除术。100例患者接受了胸膜外剥离术,209例患者接受了整块切除术。肿瘤分期为IIB期(n = 212)和IIIA期(n = 97)。IIB期和IIIA期患者的5年总生存率分别为40%和12%(p < 10⁻⁴)。多因素分析显示,男性和肿瘤体积较大是IIB期患者预后不良的独立指标。在胸壁侵犯仅限于脏层胸膜的IIB期患者中,与胸膜外切除术相比,整块切除术的5年生存率更高(60.3%对39.1%;p = 0.03)。在IIIA期患者中,多因素分析揭示了两个独立的预后因素:切除肋骨的数量以及辅助性胸壁和纵隔放疗。

结论

淋巴结转移的存在对该亚组患者的生存有灾难性影响。强烈建议整块切除术作为手术治疗的标准,当实现完全R0切除时,N0患者似乎不需要辅助放疗。对于巨大肿瘤(大于6 cm),本报告表明围手术期化疗的作用需要进一步评估。

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