Ren Jianghao, Ren Jiangbin, Wang Kan, Xu Yuanyuan, Zhu Mingyang, Ren Ting, Guo Zhiyi, Li Ruonan, Huang Jiazheng, Tan Qiang
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
Eur J Surg Oncol. 2023 May;49(5):950-957. doi: 10.1016/j.ejso.2023.01.022. Epub 2023 Jan 28.
Recently, early-stage lung cancer has been drawing more attention, especially in screening and treatment. Visceral pleural invasion in stage IB cancer is considered as risk factor for poor prognosis. Herein, we aimed to study the distinction between the different locations of visceral pleural invasion.
In this retrospective cohort study, we summarized 58,242 patient cases that underwent surgery from 2015 to 2018 at Shanghai Chest Hospital. Of those patients, 389 met the inclusion criteria. Patients with PL3 pleural invasion were excluded. The patients were dichotomized into the interlobar pleural and peripheral pleural groups. The outcomes measured were overall survival (OS) and recurrence-free survival (RFS) rates.
According to the initial analysis, the baseline characteristics of the two groups were largely balanced. In multivariate Cox analyses, we found that the location of visceral pleural invasion was not a risk factor for prognosis in the overall population (RFS: P = 0.726, OS: P = 0.599). However, we discovered that relative to patients with peripheral pleura invasion, those with interlobar pleura invasion, PL1 invasion, lesions with greater than 3 cm solid components, and those who underwent segmentectomy had a compromised prognosis. Additionally, tumors larger than 3 cm in size with interlobar pleura invasion showed poor prognosis in patients who underwent postoperative chemotherapy.
In most cases, the location of tumor invasion did not worsen the postoperative prognosis of stage IB non-small cell lung cancer patients with visceral pleural invasion. However, interlobar pleural invasion still had some potential risks compared to that of peripheral pleural invasion.
近年来，早期肺癌越来越受到关注，尤其是在筛查和治疗方面。IB期癌症的脏层胸膜侵犯被认为是预后不良的危险因素。在此，我们旨在研究脏层胸膜侵犯不同部位之间的差异。
在这项回顾性队列研究中，我们总结了2015年至2018年在上海胸科医院接受手术的58242例患者病例。其中，389例符合纳入标准。排除PL3胸膜侵犯的患者。将患者分为叶间胸膜组和外周胸膜组。测量的结局指标为总生存率（OS）和无复发生存率（RFS）。
根据初步分析，两组的基线特征基本平衡。在多因素Cox分析中，我们发现脏层胸膜侵犯的部位在总体人群中不是预后的危险因素（RFS：P = 0.726，OS：P = 0.599）。然而，我们发现相对于外周胸膜侵犯的患者，叶间胸膜侵犯、PL1侵犯、实性成分大于3 cm的病变以及接受肺段切除术的患者预后较差。此外，叶间胸膜侵犯且肿瘤大小大于3 cm的患者在接受术后化疗时预后较差。
在大多数情况下，肿瘤侵犯部位并未使伴有脏层胸膜侵犯的IB期非小细胞肺癌患者的术后预后恶化。然而，与外周胸膜侵犯相比，叶间胸膜侵犯仍有一些潜在风险。
