Motono Nozomu, Iwai Shun, Yoshihito Iijima, Usuda Katsuo, Yamada Sohsuke, Uramoto Hidetaka
Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, 920-0293, Japan.
Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, 920-0293, Japan.
J Thorac Dis. 2020 Oct;12(10):5647-5656. doi: 10.21037/jtd-20-1543.
The prognosis of non-small-cell lung cancer (NSCLC) patients with pleural dissemination is poor, and pleural dissemination is generally considered a contraindication for radical surgery. However, if pleural dissemination is missed intraoperatively, patients with false-negative stage IV NSCLC cannot receive appropriate chemotherapy, and their prognosis might worsen.
In the present study, we enrolled 144 patients who received surgery for NSCLC between January 2008 and December 2019 with available data on the maximum standardized uptake value (SUV) on positron emission tomography (PET) with lesions adjacent to the visceral pleura and without lesions invading the chest wall.
Seven patients who had pleural dissemination were compared with 137 patients who had not pleural dissemination. The relationships between pleural dissemination and the clinicopathological variables were analyzed, and significant differences in the histopathological type (P=0.03), and differentiation (P<0.01) were noted. It was suggested that squamous cell carcinoma tended not to show dissemination to the pleural cavity. The logistic regression analyses of the predictive factors related to pleural dissemination in non-squamous cell carcinoma patients were analyzed, and the age (P=0.01) and differentiation (P<0.01) were identified as significant predictive factors related to pleural dissemination.
Cases with non-squamous cell carcinoma, a young age, and poor differentiation of undifferentiated grade of histological differentiation are factors associated with early pleural cavity dissemination.
伴有胸膜播散的非小细胞肺癌（NSCLC）患者预后较差，胸膜播散通常被视为根治性手术的禁忌证。然而，如果术中漏诊胸膜播散，IV期NSCLC假阴性患者无法接受适当的化疗，其预后可能会恶化。
在本研究中，我们纳入了2008年1月至2019年12月期间接受NSCLC手术的144例患者，这些患者有关于正电子发射断层扫描（PET）上最大标准化摄取值（SUV）的可用数据，病变邻近脏层胸膜且无侵犯胸壁的病变。
将7例有胸膜播散的患者与137例无胸膜播散的患者进行比较。分析胸膜播散与临床病理变量之间的关系，发现组织病理学类型（P=0.03）和分化程度（P<0.01）存在显著差异。提示鳞状细胞癌往往不向胸腔播散。对非鳞状细胞癌患者胸膜播散相关预测因素进行逻辑回归分析，确定年龄（P=0.01）和分化程度（P<0.01）为与胸膜播散相关的显著预测因素。
非鳞状细胞癌、年龄较小以及组织学分化未分化等级的低分化是与早期胸腔播散相关的因素。
