Adachi Hiroyuki, Tsuboi Masahiro, Nishii Teppei, Yamamoto Taketsugu, Nagashima Takuya, Ando Kohei, Ishikawa Yoshihiro, Woo Tekkan, Watanabe Katsuya, Kumakiri Yutaka, Maehara Takamitsu, Morohoshi Takao, Nakayama Haruhiko, Masuda Munetaka
Department of Surgery, Yokohama City University, Yokohama, Japan
Department of Surgery, Yokohama City University, Yokohama, Japan.
Eur J Cardiothorac Surg. 2015 Nov;48(5):691-7; discussion 697. doi: 10.1093/ejcts/ezu515. Epub 2015 Jan 5.
Although the prognostic implications of visceral pleural invasion (VPI) are well established, it remains controversial whether the extent of VPI affects survival in patients with completely resected non-small-cell lung cancer (NSCLC). In addition, the impact of VPI according to nodal status is unclear. We evaluated the influence of the extent of pleural invasion on survival by analysing a multicentre retrospective database of patients who had undergone surgery for NSCLC.
We retrospectively reviewed the clinicopathological characteristics and outcomes of 639 patients with NSCLC who underwent anatomic complete resection from 2005 to 2007 at nine hospitals affiliated with the Yokohama Consortium of Thoracic Surgeons.
The median follow-up was 65.0 months. The extent of pleural invasion was PL0 in 462 patients, PL1 in 135 and PL2 in 42. The 5-year overall survival rate was significantly higher in patients with PL0 tumours (75.9%) than in those with PL1 (63.6%) or PL2 tumours (54.1%). On subgroup analysis according to nodal status, PL0 was associated with a higher survival rate than that of PL1 or PL2 tumours in patients with N0 or N1 metastasis, but not in those with N2 metastasis. There was no difference between PL1 and PL2 in any subgroup.
Our results suggest that the presence of VPI, rather than the extent, has an impact on postoperative survival in patients with NSCLC who have N0 or N1 metastasis. Because very few previous studies have addressed the effects of VPI in patients with N1 disease, further re-evaluation of the prognostic impact of VPI is necessary in this subgroup of patients.
虽然脏层胸膜侵犯（VPI）的预后意义已得到充分证实，但对于完全切除的非小细胞肺癌（NSCLC）患者，VPI的范围是否影响生存仍存在争议。此外，VPI根据淋巴结状态的影响尚不清楚。我们通过分析一个多中心回顾性数据库，评估了胸膜侵犯范围对接受NSCLC手术患者生存的影响。
我们回顾性分析了2005年至2007年间在横滨胸外科医师联盟所属的9家医院接受解剖性完全切除的639例NSCLC患者的临床病理特征和预后。
中位随访时间为65.0个月。462例患者的胸膜侵犯范围为PL0，135例为PL1，42例为PL2。PL0肿瘤患者的5年总生存率（75.9%）显著高于PL1（63.6%）或PL2肿瘤患者（54.1%）。根据淋巴结状态进行亚组分析时，在N0或N1转移患者中，PL0的生存率高于PL1或PL2肿瘤患者，但在N2转移患者中并非如此。在任何亚组中，PL1和PL2之间均无差异。
我们的结果表明，VPI的存在而非范围对有N0或N1转移的NSCLC患者的术后生存有影响。由于以前很少有研究探讨VPI对N1期疾病患者的影响，因此有必要对这一亚组患者中VPI的预后影响进行进一步重新评估。
