Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Ann Surg Oncol. 2012 Sep;19(9):3057-64. doi: 10.1245/s10434-012-2354-y. Epub 2012 Apr 11.
In order to improve prognostic applications and treatment decisions, we report our experiences of visceral pleural surface invasion (VPSI) in non-small cell lung cancers (NSCLCs) with pleural retraction.
A total of 321 NSCLCs with pleural retraction were identified by carefully inspecting surgically resected specimens. The extent of pleural invasion, including the use of elastic stain, was evaluated. Patients with and without VPSI were compared for clinicopathologic parameters and survival.
VPSI was identified in 170 (53.0 %) of the stage I-III cases and 98 (43.4 %) of the patients with stage I disease. VPSI was associated with a higher frequency of tumor size greater than 3 cm, moderate/poor differentiation, vascular invasion, mediastinal lymph node metastasis, extranodal involvement, and higher TNM stages. Multivariate analysis revealed VPSI to be a significant independent predictor of unfavorable prognosis. The 5-year survival of patients with and without VPSI was 57.9 and 83.0 %, respectively (P = 0.001), and was 74.3 and 88.5 % (P = 0.005) in stages I-III and stage I disease, respectively.
VPSI is an independent factor for poor prognosis in NSCLCs, regardless of lymph node status. Stage IB NSCLCs with PL1 pleural invasion are associated with a survival rate similar to that of stage IA NSCLCs and could be classified as T1 lesions. While surgical treatment is adequate in these patients, stage IB NSCLCs with VPSI have poor prognosis, and these patients should be considered for adjuvant chemotherapy.
为了改善预后应用和治疗决策，我们报告了伴有胸膜回缩的非小细胞肺癌（NSCLC）中内脏胸膜表面侵犯（VPSI）的经验。
通过仔细检查手术切除标本，共确定了 321 例伴有胸膜回缩的 NSCLC。评估了胸膜侵犯的程度，包括使用弹性染色。比较了有和没有 VPSI 的患者的临床病理参数和生存情况。
Ⅰ-Ⅲ期病例中 170 例（53.0%）和Ⅰ期患者中 98 例（43.4%）发现 VPSI。VPSI 与肿瘤大小大于 3cm、中/低分化、血管侵犯、纵隔淋巴结转移、结外侵犯和更高的 TNM 分期的频率较高有关。多变量分析显示 VPSI 是预后不良的独立预测因素。有和没有 VPSI 的患者的 5 年生存率分别为 57.9%和 83.0%（P=0.001），在Ⅰ-Ⅲ期和Ⅰ期疾病中分别为 74.3%和 88.5%（P=0.005）。
VPSI 是 NSCLC 预后不良的独立因素，与淋巴结状态无关。PL1 胸膜侵犯的 IB 期 NSCLC 与 IA 期 NSCLC 的生存率相似，可归类为 T1 病变。虽然这些患者的手术治疗是足够的，但有 VPSI 的 IB 期 NSCLC 预后不良，这些患者应考虑辅助化疗。
