McCaughan B C, Martini N, Bains M S, McCormack P M
J Thorac Cardiovasc Surg. 1985 Jun;89(6):836-41.
From 1974 through 1983, 125 patients underwent operation at Memorial Sloan-Kettering Cancer Center for non-small cell carcinoma of the lung invading the chest wall. (Excluded are those with superior sulcus tumors or distant metastases at presentation.) Eighty patients were male and 45 were female. Ages ranged from 33 to 88 years (median 60 years). Histologically, the tumors were epidermoid carcinoma in 46%, adenocarcinoma in 46%, and large cell carcinoma in 8%. All patients underwent thoracotomy (pneumonectomy 19, bilobectomy seven, lobectomy 75, wedge resection 10, and no pulmonary resection 14), with an operative mortality of 4%. At thoracotomy, mediastinal lymph node dissection was routinely performed, and the postsurgical stage was T3 N0 M0 in 53%, T3 N1 M0 in 13%, and T3 N2 M0 in 34%. Extrapleural resection was performed in 66 patients. En bloc resection of chest wall and lung was performed in 45 patients with an operative mortality of 2%. Complete resection of tumor was possible in 77 patients (62%). Extension of tumor beyond the parietal pleura significantly decreased resectability. The median survival of 48 patients having incomplete resection was 9 months, despite perioperative interstitial and external radiation. The actuarial 5 year survival rate (Kaplan-Meier) of 77 patients having complete resection was 40%. This percentage was not significantly influenced by the patient's age or sex or by tumor size or histologic type. Lymphatic metastases significantly reduced survival, with a 5 year actuarial survival rate of 56% for patients with T3 N0 M0 disease and 21% for those with T3 N1 M0 or T3 N2 M0 disease (p = 0.005). The extent of tumor invasion of the chest wall appeared to influence survival, but in the absence of lymphatic metastases the difference at 5 years was not significant. Complete resection offers a significant chance for long-term survival in lung cancer directly extending into parietal pleura and chest wall. Extrapleural resection or en bloc chest wall resection can be performed with a low operative mortality and an expected 5 year survival in excess of 50% in the absence of lymphatic metastases.
1974年至1983年期间，125例患者在纪念斯隆凯特琳癌症中心接受了手术，治疗侵犯胸壁的非小细胞肺癌。（排除初诊时患有肺上沟瘤或远处转移的患者。）80例为男性，45例为女性。年龄范围为33至88岁（中位年龄60岁）。组织学上，肿瘤为表皮样癌的占46%，腺癌占46%，大细胞癌占8%。所有患者均接受了开胸手术（全肺切除术19例，双叶切除术7例，肺叶切除术75例，楔形切除术10例，未行肺切除术14例），手术死亡率为4%。开胸手术时常规进行纵隔淋巴结清扫，术后分期为T3 N0 M0的占53%，T3 N1 M0的占13%，T3 N2 M0的占34%。66例患者进行了胸膜外切除术。45例患者进行了胸壁和肺的整块切除术，手术死亡率为2%。77例患者（62%）实现了肿瘤的完全切除。肿瘤侵犯超出脏层胸膜显著降低了可切除性。48例切除不完全的患者的中位生存期为9个月，尽管围手术期进行了间质放疗和外照射。77例完全切除患者的精算5年生存率（Kaplan-Meier法）为40%。该百分比不受患者年龄、性别、肿瘤大小或组织学类型的显著影响。淋巴转移显著降低了生存率，T3 N0 M0疾病患者的5年精算生存率为56%，T3 N1 M0或T3 N2 M0疾病患者为21%（p = 0.005）。肿瘤侵犯胸壁的程度似乎影响生存率，但在无淋巴转移的情况下，5年时的差异不显著。完全切除为直接侵犯脏层胸膜和胸壁的肺癌患者提供了显著的长期生存机会。胸膜外切除术或胸壁整块切除术可在低手术死亡率下进行，在无淋巴转移的情况下预期5年生存率超过50%。
