Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China.
Chin Med J (Engl). 2010 Feb 5;123(3):265-8.
IIIb-T(4) non-small cell lung cancer (NSCLC) is commonly considered a contraindication to surgery, although chemo-radiotherapy also achieves a poor survival rate. We reviewed our experience with T(4) NSCLC patients who underwent surgery to explore the indications and prognostic factors of surgical treatment of lung cancer invading the left atrium and great vessels.
We investigated a cohort of 105 patients, 79 men and 26 women, who underwent surgery from May 1996 to July 2008. Their pathological staging was T(4)N(0)-(2)M(0). The median age was 59 years, ranging from 36 to 75 years. Patients were grouped based on invading sites: tumors invading the left atrium (LA group), tumors invading the superior vena cava (SVC group), and tumors invading the intrapericardial pulmonary artery (PA group). Patients were further characterized based upon the type of operation, complete resection and incomplete resection groups, and on the lymph node pathological status, N(0), N(1) and N(2) groups. We calculated the overall five-year survival rate.
All patients received resection of primary lesions, with partial resection of the left atrium in the LA group (n = 25), angioplasty of superior vena cava in the SVC group (n = 23) and intrapericardial ligation of the pulmonary artery in the PA group (n = 57). Complete resection was possible in 77 patients (73.3%). The overall survival rate of the 105 patients was 41.0% at 5 years; 36.0% for the LA group, 34.8% for the SVC group and 45.6% for the PA group. Pathological N status significantly influenced the overall 5-year survival rate; 61.5% for N(0), 51.1% for the N(1) and 11.8% for the N(2) groups (N(2) group versus N(0) group, P < 0.0001, N(2) versus N(1) group, P < 0.0001). Surgical resection also influenced survival; 49.4% for the complete resection group and 17.9% for the incomplete resection group (P < 0.0001). Cox regression analysis demonstrated that pathological N status was a significant independent predictor of prognosis.
Pathological N status is a significant independent predictor for survival of patients with IIIb-T(4) lung cancer invading the left atrium and great vessels. The completeness of resection has a significant influence on the overall 5-year survival rate. Surgery for T(4) lung cancer may be effective in patients without mediastinal lymph node involvement.
IIIb-T（4）非小细胞肺癌（NSCLC）通常被认为是手术的禁忌症，尽管化疗放疗也能获得较差的生存率。我们回顾了 T（4）NSCLC 患者接受手术的经验，以探讨侵犯左心房和大血管的肺癌手术治疗的适应证和预后因素。
我们调查了 105 例患者，其中男性 79 例，女性 26 例，于 1996 年 5 月至 2008 年 7 月接受手术。其病理分期为 T（4）N（0）-2 M（0）。中位年龄为 59 岁，范围为 36-75 岁。根据侵犯部位将患者分为左心房（LA 组）、上腔静脉（SVC 组）和心包内肺动脉（PA 组）肿瘤侵犯组。根据手术方式、完全切除和不完全切除组以及淋巴结病理状态、N（0）、N（1）和 N（2）组进一步对患者进行分类。我们计算了总的五年生存率。
所有患者均接受了原发性病变切除术，LA 组 25 例患者行左心房部分切除术，SVC 组 23 例患者行上腔静脉血管成形术，PA 组 57 例患者行心包内肺动脉结扎术。77 例患者（73.3%）可完全切除。105 例患者的总体 5 年生存率为 41.0%；LA 组为 36.0%，SVC 组为 34.8%，PA 组为 45.6%。病理 N 状态显著影响总体 5 年生存率；N（0）组为 61.5%，N（1）组为 51.1%，N（2）组为 11.8%（N（2）组与 N（0）组比较，P＜0.0001，N（2）组与 N（1）组比较，P＜0.0001）。手术切除也影响生存；完全切除组为 49.4%，不完全切除组为 17.9%（P＜0.0001）。Cox 回归分析表明，病理 N 状态是影响 IIIb-T（4）肺癌患者预后的显著独立预测因素。
病理 N 状态是 IIIb-T（4）肺癌侵犯左心房和大血管患者生存的显著独立预测因素。切除的完整性对总 5 年生存率有显著影响。对于没有纵隔淋巴结受累的 T（4）肺癌患者，手术可能是有效的。
