Department of General Thoracic Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure, Hiroshima, 737-0023, Japan.
BMC Cancer. 2022 Apr 28;22(1):469. doi: 10.1186/s12885-022-09600-6.
The prognosis of patients with lung cancer who demonstrate pleural plaques intraoperatively, which may be associated with exposure to asbestos, is unclear. Here, we compared the clinicopathological characteristics and prognosis of these patients to those of patients without pleural plaques.
We included patients who underwent curative-intent resection for non-small cell lung cancer. We retrospectively investigated the relationship of intrathoracic findings of pleural plaques with clinicopathological features and prognosis.
Pleural plaques were found in 121/701 patients (17.3%) during surgery. The incidence of squamous cell carcinoma (P < 0.001) and the pathological stage (P = 0.021) were higher in patients with pleural plaques. Overall survival was significantly worse in patients with pleural plaques (5-year rate; 64.5% vs. 79.3%; P < 0.001), and the same finding was noted in clinical stage I patients (5-year rate; 64.8% vs. 83.4%; P < 0.001). In multivariable analysis, the presence of pleural plaques was a significant predictor of overall survival in patients with clinical stage I (hazard ratio, 1.643; P = 0.036). In the analysis among patients with emphysema more severe than Goddard score 5 points or interstitial pneumonia, overall survival was significantly worse in those with pleural plaques than in those without pleural plaques (5-year rate; 66.3% vs. 49.5%; P < 0.001).
Patients with non-small cell lung cancer who underwent resection and demonstrated pleural plaques intraoperatively had a significantly worse prognosis. It is important to recognize the presence of pleural plaques intraoperatively, and our findings will be useful in determining the treatment and follow-up strategy for such patients with lung cancer and pleural plaques on intrathoracic examination.
术中发现有胸膜斑的肺癌患者的预后尚不清楚，这些胸膜斑可能与石棉暴露有关。本研究旨在比较此类患者与无胸膜斑患者的临床病理特征和预后。
我们纳入了因非小细胞肺癌而行根治性切除术的患者。回顾性调查了胸腔内胸膜斑的存在与临床病理特征和预后的关系。
手术中发现 121/701 例（17.3%）患者存在胸膜斑。与无胸膜斑的患者相比，有胸膜斑的患者中鳞状细胞癌（P<0.001）和病理分期（P=0.021）更高。有胸膜斑的患者总生存率明显较差（5 年生存率；64.5%比 79.3%；P<0.001），在临床 I 期患者中也有同样的发现（5 年生存率；64.8%比 83.4%；P<0.001）。多变量分析显示，在临床 I 期患者中，胸膜斑的存在是总生存率的显著预测因素（危险比，1.643；P=0.036）。在肺气肿评分大于 5 分或间质性肺炎的患者亚组分析中，有胸膜斑的患者总生存率明显差于无胸膜斑的患者（5 年生存率；66.3%比 49.5%；P<0.001）。
行切除术的非小细胞肺癌患者术中发现有胸膜斑，其预后明显较差。术中认识到胸膜斑的存在很重要，我们的发现将有助于确定此类肺癌患者和胸腔内检查发现有胸膜斑的患者的治疗和随访策略。
