Jiwangga Dhihintia, Cho Sukki, Kim Kwhanmien, Jheon Sanghoon
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul, Korea; Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Thorac Surg. 2017 Apr;103(4):1126-1131. doi: 10.1016/j.athoracsur.2016.09.052. Epub 2016 Dec 16.
Visceral pleural invasion (VPI) is well known to be a poor prognostic factor in lung adenocarcinoma. There were few studies reporting postoperative recurrence pattern in lung adenocarcinoma with VPI. This study was to evaluate the clinical effect of VPI on recurrence pattern in pathologic stage I lung adenocarcinoma after curative resection.
Among 574 patients with pathologic stage I lung adenocarcinoma after complete resection between 2003 and 2012, the clinicopathologic characteristics of 89 patients (16%) who had recurrence were retrospectively reviewed. The pathologic findings, postrecurrence survival, and patterns of recurrence were compared between patients with VPI and without VPI.
Median follow-up duration was 53.6 months. The VPI was found in 43 patients (group I) and not found in 46 patients (group II). Both total tumor size and invasive size were larger in group I (3.2 versus 2.7 cm and 2.5 versus 2.1 cm; p < 0.05). The median duration of overall survival was 58 months in group I and 76 months in group II. As patterns of recurrence, pleural seeding was found in 25 patients, and the percentage of pleural seeding was significantly higher in group I than group II (44.2% versus 13.0%; p = 0.001). In group I, bilateral lung metastasis was significantly common (39.5% versus 13.0%; p = 0.004), and increasing percentage of pleural seeding was observed as the invasive tumor size grows.
The presence of VPI was a significant predictable factor for pleural seeding and bilateral lung metastasis as patterns of recurrence after complete resection in pathologic stage I lung adenocarcinoma.
众所周知，脏层胸膜侵犯（VPI）是肺腺癌预后不良的因素。关于伴有VPI的肺腺癌术后复发模式的研究较少。本研究旨在评估VPI对I期肺腺癌根治性切除术后复发模式的临床影响。
回顾性分析2003年至2012年间574例I期肺腺癌根治性切除患者的临床病理特征，其中89例（16%）出现复发。比较有VPI和无VPI患者的病理结果、复发后生存率和复发模式。
中位随访时间为53.6个月。43例患者（I组）发现有VPI，46例患者（II组）未发现。I组的肿瘤总体大小和浸润大小均更大（分别为3.2对2.7 cm和2.5对2.1 cm；p<0.05）。I组的总生存期中位数为58个月，II组为76个月。作为复发模式，25例患者出现胸膜播散，I组胸膜播散的比例显著高于II组（44.2%对13.0%；p=0.001）。在I组中，双侧肺转移显著常见（39.5%对13.0%；p=0.004），并且随着浸润肿瘤大小的增加，胸膜播散的比例也在增加。
VPI的存在是I期肺腺癌根治性切除术后胸膜播散和双侧肺转移这两种复发模式的重要预测因素。
