Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy.
Division of Thoracic Surgery, Policlinico Umberto I, Faculty of Pharmacy and Medicine, University of Rome 'Sapienza', Rome, Italy.
Thorac Cancer. 2020 Feb;11(2):232-242. doi: 10.1111/1759-7714.13217. Epub 2019 Dec 18.
Tumor with adjacent lobe invasion (T-ALI) is an uncommon condition. Controversy still exists regarding the optimal resection of adjacent lobe invasion, and the prognostic value in relation to fissure integrity at the tumor invasion point. The aims of this paper were to evaluate the prognosis of T-ALI with regard to fissure integrity, and type of resection.
This was a retrospective multicenter study which included all consecutive patients with T-ALI undergoing surgical treatment. Based on radiological, intraoperative and histological findings, T-ALI patients were differentiated into two groups based on whether the fissure was complete (T-ALI-A group) or incomplete (T-ALI-D Group) at the level of tumor invasion point. Clinico-pathological features and survival of two study groups were analyzed and compared.
Study population included 135 patients, of these 98 (72%) were included into T-ALI-A group, and 37 (38%) into T-ALI-D Group. T-ALI-D patients had better overall survival than T-ALI-A patients (63.9 ± 7.0 vs. 48.9 ± 3.9; respectively, P = 0.01) who presented with a higher incidence of lymph node involvement (35% vs. 4%; P = 0.004), and recurrence rate (43% vs. 16%; P = 0.01). At multivariable analysis, T-ALI-D (P = 0.01), pN0 stage (P = 0.0002), and pT≤5 cm (P = 0.0001) were favorable survival prognostic factors.
T-ALI-D presented a better prognosis than T-ALI-A while extent of resection had no effect on survival. Thus, in patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe rather than lobectomy could be indicated.
The extent of resection of adjacent lobe had no effect on survival while T-ALI-D, pN0 stage, and pT≤5 cm were significant prognostic factors. In patients with small T-ALI-D and without lymph node involvement, sublobar resection of adjacent lobe could be indicated as an alternative to lobectomy.
肿瘤累及邻近肺叶（T-ALI）是一种不常见的情况。对于累及邻近肺叶的肿瘤的最佳切除方式，以及肿瘤侵犯部位的裂隙完整性与预后的关系，仍存在争议。本文旨在评估 T-ALI 患者的预后与裂隙完整性和切除类型的关系。
这是一项回顾性多中心研究，纳入了所有接受手术治疗的 T-ALI 连续患者。根据影像学、术中及组织学发现，将 T-ALI 患者分为肿瘤侵犯部位裂隙完整（T-ALI-A 组）和不完整（T-ALI-D 组）两组。分析并比较两组患者的临床病理特征和生存情况。
研究人群包括 135 例患者，其中 98 例（72%）纳入 T-ALI-A 组，37 例（38%）纳入 T-ALI-D 组。T-ALI-D 患者的总生存率优于 T-ALI-A 患者（63.9±7.0 vs. 48.9±3.9；P=0.01），前者淋巴结受累（35% vs. 4%；P=0.004）和复发率（43% vs. 16%；P=0.01）更高。多变量分析显示，T-ALI-D（P=0.01）、pN0 期（P=0.0002）和 pT≤5 cm（P=0.0001）是有利的生存预后因素。
与 T-ALI-A 相比，T-ALI-D 患者的预后更好，而切除范围对生存无影响。因此，对于 T-ALI-D 较小且无淋巴结受累的患者，可考虑行邻近肺叶亚肺叶切除术，而非肺叶切除术。
切除范围对生存无影响，而 T-ALI-D、pN0 期和 pT≤5 cm 是重要的预后因素。对于 T-ALI-D 较小且无淋巴结受累的患者，可考虑行邻近肺叶亚肺叶切除术作为肺叶切除术的替代方法。
