Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Surgery, Hiroshima City Asa Citizen Hospital, Hiroshima, Japan.
Ann Thorac Surg. 2018 May;105(5):1543-1550. doi: 10.1016/j.athoracsur.2017.12.007. Epub 2018 Jan 9.
The purpose of this study was to elucidate the clinical behavior of right middle lobe lung cancer, with focus on the tumor location.
We reviewed retrospectively 711 patients who underwent lobectomy or bilobectomy for clinical stage I non-small cell lung cancer (upper lobe, 346; middle lobe, 82; lower lobe, 283). Factors affecting survival were assessed by log rank tests and Cox regression analyses.
The prognosis of patients with segment 5 tumors (n = 39) was significantly worse than that of patients with segment 4 tumors (n = 43; 5-year overall survival rates, 69.8% versus 87.6%, p = 0.040; and 5-year recurrence-free survival rates, 58.4% versus 73.0%, p = 0.029). Segment 5 tumors were an independent factor for poor prognosis in multivariable Cox regression analysis, and tended to cause more pathologic mediastinal lymph node metastases than segment 4 tumors (12.8% versus 2.3%, p = 0.097). Compared with tumors in the other lobes, patients with segment 4 tumors demonstrated no significant difference in prognosis; however, patients with segment 5 tumors demonstrated a significantly and outstandingly worse prognosis than patients with other lobe tumors (5-year overall survival rates, 69.8% versus 82.2%, p = 0.020; and 5-year recurrence-free survival rates, 58.4% versus 71.4%, p = 0.0071).
Patients with segment 5 tumors had a worse prognosis than patients with segment 4 and other lobe tumors. We speculate that is because segment 5 tumors cause more metastases to the mediastinal lymph nodes. Tumor location was an important prognostic factor for patients with right middle lobe lung cancer.
本研究旨在阐明右中叶肺癌的临床行为，重点关注肿瘤部位。
我们回顾性分析了 711 例接受肺叶切除术或双肺叶切除术治疗的 I 期非小细胞肺癌患者（上叶 346 例，中叶 82 例，下叶 283 例）。通过对数秩检验和 Cox 回归分析评估影响生存的因素。
段 5 肿瘤（n=39）患者的预后明显差于段 4 肿瘤（n=43）患者（5 年总生存率分别为 69.8%和 87.6%，p=0.040；5 年无复发生存率分别为 58.4%和 73.0%，p=0.029）。在多变量 Cox 回归分析中，段 5 肿瘤是预后不良的独立因素，且倾向于比段 4 肿瘤引起更多的病理性纵隔淋巴结转移（12.8%比 2.3%，p=0.097）。与其他肺叶的肿瘤相比，段 4 肿瘤患者的预后无显著差异；然而，段 5 肿瘤患者的预后明显比其他肺叶肿瘤患者差（5 年总生存率分别为 69.8%和 82.2%，p=0.020；5 年无复发生存率分别为 58.4%和 71.4%，p=0.0071）。
段 5 肿瘤患者的预后比段 4 肿瘤和其他肺叶肿瘤患者差。我们推测这是因为段 5 肿瘤导致更多纵隔淋巴结转移。肿瘤位置是右中叶肺癌患者的一个重要预后因素。
