Yutaka Yojiro, Terada Kazuhiko, Tanaka Satona, Yamada Yoshito, Ohsumi Akihiro, Nakajima Daisuke, Hamaji Masatsugu, Menju Toshi, Yoshizawa Akihiko, Date Hiroshi
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
J Thorac Dis. 2022 Dec;14(12):4660-4668. doi: 10.21037/jtd-22-976.
Primary lung cancer that invades the chest wall is classified as T3 regardless of the depth of invasion. This study assessed the prognostic impact of pathologically confirmed rib invasion in patients with pT3N0-1 lung cancer requiring chest wall resection.
We retrospectively analyzed the records of patients with non-small cell lung cancer (NSCLC) who underwent combined lung and chest wall resection with rib involvement from 2006 to 2019. The median follow-up period was 64.0 months.
In total, 42 patients (41 men, 1 woman) were enrolled. The median patient age was 64 years (range, 42-79 years). The median tumor size before treatment was 56.5 mm (range, 21-80 mm), and an osteolytic sign was identified on computed tomography (CT) in 42.9% (18/42). Among 27 patients who received induction chemoradiotherapy, 5 (18.5%) achieved a complete pathological response. The operations comprised 36 lobectomies, 5 segmentectomies, and 1 wedge resection with resection of 2.5 ribs on average. Pathological examination revealed rib invasion in 18 (42.9%) patients. The 5-year disease-free and overall survival rates with pathological rib invasion were 44.4% and 77.4% (P=0.0114), respectively and those without pathological rib invasion were 44.7% and 81.3% (P=0.0222), respectively. Pathologically confirmed rib invasion was the only factor identified to have a prognostic impact in the univariate and multivariate analyses [hazard ratio (HR), 5.98; 95% confidence interval (CI): 1.37-26.1]. Locoregional recurrence and distant metastases were more common in patients with than without pathologically confirmed rib invasion [4 (22.2%) and 6 (33.3%), respectively, among 18 patients with pathological rib invasion; 2 (8.3%) and 3 (12.5%), respectively, among 24 patients without pathological rib invasion] (P=0.0073).
Pathologically confirmed rib invasion was found to have a significant unfavorable prognostic impact in patients with pT3N0-1 lung cancer requiring chest wall resection. Multimodal therapy may be preferable in these patients to prevent local and distant relapse.
侵犯胸壁的原发性肺癌无论侵犯深度如何均归类为T3。本研究评估了在需要进行胸壁切除的pT3N0-1期肺癌患者中，经病理证实的肋骨侵犯对预后的影响。
我们回顾性分析了2006年至2019年期间接受肺和胸壁联合切除且伴有肋骨受累的非小细胞肺癌（NSCLC）患者的记录。中位随访期为64.0个月。
共纳入42例患者（41例男性，1例女性）。患者中位年龄为64岁（范围42-79岁）。治疗前肿瘤中位大小为56.5mm（范围21-80mm），42.9%（18/42）的患者在计算机断层扫描（CT）上发现溶骨征象。在27例接受诱导放化疗的患者中，5例（18.5%）达到完全病理缓解。手术包括36例肺叶切除术、5例肺段切除术和1例楔形切除术，平均切除2.5根肋骨。病理检查发现18例（42.9%）患者有肋骨侵犯。有病理肋骨侵犯患者的5年无病生存率和总生存率分别为44.4%和77.4%（P=0.0114），无病理肋骨侵犯患者的5年无病生存率和总生存率分别为44.7%和81.3%（P=0.0222）。在单因素和多因素分析中，经病理证实的肋骨侵犯是唯一被确定对预后有影响的因素[风险比（HR），5.98；95%置信区间（CI）：1.37-26.1]。有病理证实肋骨侵犯的患者局部区域复发和远处转移比无病理证实肋骨侵犯的患者更常见[18例有病理肋骨侵犯的患者中分别为4例（22.2%）和6例（33.3%）；24例无病理肋骨侵犯的患者中分别为2例（8.3%）和3例（12.5%）]（P=0.0073）。
在需要进行胸壁切除的pT3N0-1期肺癌患者中，经病理证实的肋骨侵犯对预后有显著不利影响。对于这些患者，多模式治疗可能更可取，以预防局部和远处复发。
