Citak N, Büyükkale S, Sayar A, Metin M, Pekçolaklar A, Gürses A
Acta Chir Belg. 2014 Jan-Feb;114(1):17-24.
Surgical treatment of T4 non-small cell lung carcinoma (NSCLC) is controversial.
Between 1998 and 2011, 70 patients undergoing pulmonary resection for T4 NSCLC were evaluated. The patients were divided into four groups: the large vessels group (n = 28), the carinal group (n = 20), the separate tumor nodules group (n = 13) and the mediastinal fat group (n = 9).
Overall mortality and morbidity were 12.9% (n = 9) and 35.7% (n = 25), respectively and there was no significant differences between the four groups (p = 0.961, p = 0.750). Complete resection was possible in 47 patients (67.1%). The pathological nodal status was as follows: N0/1 in 58 patients and N2 in 12 patients. Five-year survival rate was 28.9% for all patients and 49.6%, 18.5%, 0% and 20.5% in the carinal, large vessels, mediastinal fat and separate tumor nodule groups, respectively. The carinal group was significantly different from the other groups in terms of survival (p = 0.05). By multivariate analysis, only two factors significantly and independently influenced survival: nodal status (N0/N1 versus N2; p = 0.01) and complete resection (R0 versus R1; p = 0.06).
Resection is not a suitable approach for T4 NSCLC patients with N2 disease or incomplete resection. Resectable T4 NSCLC patients with carinal or tracheal involvement have better survival than do other T4 sub-groups.
T4期非小细胞肺癌（NSCLC）的外科治疗存在争议。
1998年至2011年间，对70例行T4期NSCLC肺切除术的患者进行了评估。患者分为四组：大血管组（n = 28）、隆突组（n = 20）、孤立肿瘤结节组（n = 13）和纵隔脂肪组（n = 9）。
总体死亡率和发病率分别为12.9%（n = 9）和35.7%（n = 25），四组之间无显著差异（p = 0.961，p = 0.750）。47例患者（67.1%）可行根治性切除。病理淋巴结状态如下：58例为N0/1，12例为N2。所有患者的五年生存率为28.9%，隆突组、大血管组、纵隔脂肪组和孤立肿瘤结节组分别为49.6%、18.5%、0%和20.5%。隆突组与其他组在生存率方面有显著差异（p = 0.05）。多因素分析显示，仅两个因素显著且独立影响生存率：淋巴结状态（N0/N1与N2；p = 0.01）和根治性切除（R0与R1；p = 0.06）。
对于N2期疾病或切除不完全的T4期NSCLC患者，手术切除并非合适的方法。可切除的伴有隆突或气管受累的T4期NSCLC患者比其他T4亚组患者的生存率更高。
