Bertolaccini Luca, Casiraghi Monica, Galetta Domenico, Petrella Francesco, Mazzella Antonio, Lo Iacono Giorgio, Girelli Lara, Bardoni Claudia, Mohamed Shehab, Musso Valeria, Sedda Giulia, Spaggiari Lorenzo
Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Front Oncol. 2023 Jan 12;12:1080765. doi: 10.3389/fonc.2022.1080765. eCollection 2022.
Superior sulcus tumour, which affects the lung's apex, is an uncommon subtype of non-small cell lung cancer (NSCLC). The current study examined the clinical characteristics and management of superior sulcus NSCLC patients in a high-volume referral oncological centre over 22 years.
Retrospective review of 100 surgeries with curative intent for superior sulcus NSCLC over 22 years (July 1998 - December 2020). The surgical approach was defined according to the lesion site and the anatomy of the thoracic inlet. Survival curves, including non-cancer-related deaths, were drawn using the Kaplan-Meier methods, and the log-rank test was used to evaluate differences in survival across groups of patients. Cox proportional hazards regression was used to assess the association between selected clinical and pathologic characteristics on OS.
54 patients received induction treatments. The surgical approach was anterior thoracotomy in 53 patients, Paulson incision in 30, and a combined in 8. The median postoperative length of stay was 11 days (range: 5 - 27 days). Overall 90-day mortality was 6.93%. The median OS was 24.3 months. After a median follow-up of 3 years, 5-year and 10-year OS rates were 33.9% and 26.4%, respectively. A significantly lower 5-year OS was observed in patients with the nodal disease (46.6% in pN0 vs 13.2% in pN+; p = 0.024), without preoperative treatments (41.0% in patients without preoperative treatments versus 17.4%; p = 0.09) and anteriorly located tumour (anterior vs posterior: 17.4% vs 49.1%; p = 0.032). Cox proportional hazards regression showed better survival in the pT1 stage (HR = 4.6; 95% CI: 1.9 - 11.2; p = 0.00076) and in R0 (HR = 4.2; 95% CI: 1.4 - 12.5; p = 0.010).
Superior sulcus tumours still represent a life-threatening condition that, while curable in a significant proportion of cases, requires complex procedures with high surgical risks and a multimodality treatment setting. An optimal surgical approach should be planned to maximise resection completeness and survival. Other factors affecting survival are related to tumour staging, emphasising the importance of a meticulous preoperative workup and candidate selection to identify those expected to benefit from a survival benefit.
上叶沟肿瘤累及肺尖，是非小细胞肺癌（NSCLC）的一种罕见亚型。本研究调查了一家大型转诊肿瘤中心22年间上叶沟NSCLC患者的临床特征及治疗情况。
回顾性分析1998年7月至2020年12月22年间100例接受了根治性手术的上叶沟NSCLC患者。根据病变部位和胸廓入口解剖结构确定手术方式。采用Kaplan-Meier方法绘制生存曲线（包括非癌症相关死亡情况），并使用对数秩检验评估各组患者生存率的差异。采用Cox比例风险回归分析来评估选定的临床和病理特征与总生存期之间的关联。
54例患者接受了诱导治疗。手术方式为53例采用前外侧开胸术，30例采用保尔森切口，8例采用联合切口。术后中位住院时间为11天（范围：5 - 27天）。90天总死亡率为6.93%。中位总生存期为24.3个月。中位随访3年后，5年和10年总生存率分别为33.9%和26.4%。有淋巴结转移的患者5年总生存率显著较低（pN0为46.6%，pN+为13.2%；p = 0.024），未接受术前治疗的患者较低（未接受术前治疗的患者为41.0%，接受术前治疗的患者为17.4%；p = 0.09），肿瘤位于前方的患者较低（前方与后方：17.4%对49.1%；p = 0.032）。Cox比例风险回归分析显示pT1期患者生存率更高（HR = 4.6；95% CI：1.9 - 11.2；p = 0.00076），切缘阴性患者生存率更高（HR = 4.2；95% CI：1.4 - 12.5；p = 0.010）。
上叶沟肿瘤仍然是一种危及生命的疾病，虽然在相当一部分病例中可以治愈，但需要复杂的手术操作且手术风险高，需要多模式治疗。应规划最佳手术方式以最大化切除完整性和生存率。影响生存的其他因素与肿瘤分期有关，强调了细致的术前检查和候选患者选择的重要性，以确定那些预期能从生存获益的患者。
