Wu Lei-Lei, Li Chong-Wu, Li Kun, Qiu Li-Hong, Xu Shu-Quan, Lin Wei-Kang, Ma Guo-Wei, Li Zhi-Xin, Xie Dong
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Front Oncol. 2022 Apr 28;12:878482. doi: 10.3389/fonc.2022.878482. eCollection 2022.
This study was to explore the difference and significance of parietal pleura invasion and rib invasion in pathological T classification with non-small cell lung cancer.
A total of 8681 patients after lung resection were selected to perform analyses. Multivariable Cox analysis was used to identify the mortality differences in patients between parietal pleura invasion and rib invasion. Eligible patients with chest wall invasion were re-categorized according to the prognosis. Cancer-specific survival curves for different pathological T (pT) classifications were presented.
There were 466 patients considered parietal pleura invasion, and 237 patients served as rib invasion. Cases with rib invasion had poorer survival than those with the invasion of parietal pleura (adjusted hazard ratio [HR]= 1.627, =0.004). In the cohort for parietal pleura invasion, patients with tumor size ≤5cm reached more satisfactory survival outcomes than patients with tumor size >5cm (unadjusted HR =1.598, =0.006). However, there was no predictive difference in the cohort of rib invasion. The results of the multivariable analysis revealed that the mortality with parietal pleura invasion plus tumor size ≤5cm were similar to patients with classification pT3 ( =0.761), and patients for parietal pleura invasion plus tumor size >5cm and pT4 had no stratified survival outcome (P =0.809). Patients identified as rib invasion had a poorer prognosis than patients for pT4 ( =0.037).
Rib invasion has a poorer prognosis than pT4. Patients with parietal pleura invasion and tumor size with 5.1-7.0cm could be appropriately up-classified from pT3 to pT4.
本研究旨在探讨非小细胞肺癌壁层胸膜侵犯和肋骨侵犯在病理T分类中的差异及意义。
选取8681例行肺切除术后的患者进行分析。采用多变量Cox分析确定壁层胸膜侵犯和肋骨侵犯患者的死亡率差异。根据预后对符合条件的胸壁侵犯患者重新分类。绘制不同病理T（pT）分类的癌症特异性生存曲线。
466例患者被认为存在壁层胸膜侵犯，237例患者存在肋骨侵犯。肋骨侵犯患者的生存率低于壁层胸膜侵犯患者（校正风险比[HR]=1.627，P=0.004）。在壁层胸膜侵犯队列中，肿瘤大小≤5cm的患者生存结局比肿瘤大小>5cm的患者更理想（未校正HR=1.598，P=0.006）。然而，在肋骨侵犯队列中没有预测差异。多变量分析结果显示，壁层胸膜侵犯加肿瘤大小≤5cm患者的死亡率与pT3分类患者相似（P=0.761），壁层胸膜侵犯加肿瘤大小>5cm和pT4患者没有分层生存结局（P=0.809）。被确定为肋骨侵犯的患者预后比pT4患者差（P=0.037）。
肋骨侵犯的预后比pT4差。壁层胸膜侵犯且肿瘤大小为5.1 - 7.0cm的患者可适当从pT3上调至pT4。
