General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France.
Ann Thorac Surg. 2010 Dec;90(6):1773-7. doi: 10.1016/j.athoracsur.2010.07.039.
Lung cancer may invade the pericardium (T3) and the intrapericardial pulmonary veins and left atrium (T4). Our purpose was to analyze the characteristics of this invading process in search of the reasons explaining its poor prognosis.
The clinical records of 4,668 patients who underwent surgery for lung cancer between January 1983 and December 2006 in two thoracic surgery centers were retrospectively reviewed. The epidemiology, pathology, and prognostic characteristics of the tumors invading the pericardium alone (T3) or with pulmonary veins and atrium (T4) were analyzed and compared with all other tumors.
There were 75 male and 16 female patients, with 85 pneumonectomies and 6 lobectomies that proved R0 in 59.3% of patients, and contained 69 squamous cell cancers, 11 adenocarcinomas, and 13 miscellaneous tumors; 12 were N0 (13.2%), 31 were N1 (34.1%), and 48 were N2 (52.8%). Pericardium alone was invaded in 32 patients (35.2%), and with pulmonary vein and atrium in 34 (37.3%) and 25 (27.5%), respectively. Patient characteristics were similar in each group. Five-year and 10-year survival rates were 15.1% and 10.4%, respectively. Frequency of pneumonectomy, R1-2 resection, and N1-2 involvement were significantly more important compared with noninvading tumors (p < 10(-6)).
Reports on T3 and T4 cancer with pericardial involvement are few, but also stress that pulmonary vein and left atrium invasion does not worsen the prognosis more than pericardial invasion alone. The rich pericardial lymph drainage might enhance the spread of tumor cells, explaining excessively high N1-N2 rates and pericardial invasion-related poor prognosis.
肺癌可能侵犯心包（T3）和心包内肺静脉及左心房（T4）。我们的目的是分析这种侵犯过程的特征，寻找解释其预后不良的原因。
回顾性分析了 1983 年 1 月至 2006 年 12 月在两个胸外科中心接受肺癌手术的 4668 例患者的临床资料。分析并比较了单纯侵犯心包（T3）或侵犯肺静脉和左心房（T4）的肿瘤以及所有其他肿瘤的流行病学、病理学和预后特征。
共有 75 例男性和 16 例女性患者，其中 85 例进行了全肺切除术，6 例进行了肺叶切除术，59.3%的患者达到了 RO 切除，其中 69 例为鳞癌，11 例为腺癌，13 例为其他肿瘤；12 例为 N0（13.2%），31 例为 N1（34.1%），48 例为 N2（52.8%）。单纯侵犯心包的患者 32 例（35.2%），侵犯肺静脉和左心房的患者分别为 34 例（37.3%）和 25 例（27.5%）。每组患者的特征相似。5 年和 10 年生存率分别为 15.1%和 10.4%。与非侵犯性肿瘤相比，全肺切除术、R1-2 切除术和 N1-2 受累的频率显著更为重要（p < 10(-6)）。
关于心包侵犯的 T3 和 T4 癌症的报道较少，但也强调肺静脉和左心房侵犯并不会比单纯心包侵犯更恶化预后。丰富的心包淋巴结引流可能增强肿瘤细胞的扩散，解释了过高的 N1-N2 率和与心包侵犯相关的不良预后。
