多灶性（T4）非小细胞肺癌的手术切除：T4分类是否有效？

Surgical resection for multifocal (T4) non-small cell lung cancer: is the T4 designation valid?

作者信息

Port Jeffrey L, Korst Robert J, Lee Paul C, Kansler Amanda L, Kerem Yaniv, Altorki Nasser K

机构信息

Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York 10021, USA.

出版信息

Ann Thorac Surg. 2007 Feb;83(2):397-400. doi: 10.1016/j.athoracsur.2006.08.030.

DOI:10.1016/j.athoracsur.2006.08.030

PMID:17257959

Abstract

BACKGROUND

The current international staging system for lung cancer designates intralobar satellites as T4 disease. In this study, we sought to determine the impact of multifocal, intralobar non-small cell lung cancer (NSCLC) on patient survival and its potential relevance to stage designation.

METHODS

We conducted a retrospective review of our thoracic surgical cancer registry from 1990 to 2005. Included were 53 patients with a resected lung cancer containing intralobar satellites detected preoperatively (n = 8) or in the resected specimen (n = 45). Patients with multicentric bronchioloalveolar cancer were excluded. All patients had an anatomic resection with mediastinal lymph node dissection. Median follow-up for the entire group was 31 months. Survival was calculated by the Kaplan-Meier method. A Cox proportional hazards regression model was performed to examine simultaneously the effects on overall survival of age, gender, nodal disease, number of satellite lesions, lymphatic invasion, and T status.

RESULTS

The median age of the 53 patients with multifocal, intralobar (T4) disease was 68 years and 31 were women. Ten patients had more than one satellite lesion. Overall 5-year survival was 47.6% (95% confidence interval [CI], 27.36% to 65.30%) for all patients with resected intralobar satellites. Patients without nodal metastases had a 5-year survival of 58.4% (95% CI, 28.76% to 79.30%). The Cox regression identified female gender (adjusted hazard ratio [HR], 0.31; 95% CI, 0.10 to 0.96; p < 0.04) as a significant prognostic variable but only a trend towards significance for nodal status (adjusted HR, 2.3; 95% CI, .83 to 6.26; p < 0.11).

CONCLUSIONS

Patients with intralobar multifocal NSCLC detected in the resected specimen have a more favorable prognosis after surgical resection than might be predicted by their stage T4 designation. Five-year survival rates, especially in T4N0 patients, more closely approximate those with stages IB or II NSCLC.

摘要

背景

当前肺癌国际分期系统将叶内卫星灶归为T4期疾病。在本研究中，我们试图确定多灶性叶内非小细胞肺癌（NSCLC）对患者生存的影响及其与分期的潜在相关性。

方法

我们对1990年至2005年胸外科癌症登记资料进行了回顾性分析。纳入53例术前（n = 8）或切除标本中（n = 45）发现有叶内卫星灶的肺癌切除患者。多中心细支气管肺泡癌患者被排除。所有患者均接受了解剖性切除及纵隔淋巴结清扫。全组患者的中位随访时间为31个月。采用Kaplan-Meier法计算生存率。进行Cox比例风险回归模型以同时检验年龄、性别、淋巴结疾病、卫星灶数量、淋巴管侵犯及T分期对总生存的影响。

结果

53例多灶性叶内（T4）疾病患者的中位年龄为68岁，女性31例。10例患者有一个以上卫星灶。所有切除叶内卫星灶的患者5年总生存率为47.6%（95%置信区间[CI]，27.36%至65.30%）。无淋巴结转移患者的5年生存率为58.4%（95%CI，28.76%至79.30%）。Cox回归分析确定女性（校正风险比[HR]，0.31；95%CI，0.10至0.96；p < 0.04）为显著的预后变量，但淋巴结状态仅具有显著趋势（校正HR，2.3；95%CI，0.83至6.26；p < 0.11）。