临床ⅠA 期非小细胞肺癌内脏胸膜侵犯与跳跃性 N2 转移的相关性。
The association of visceral pleural invasion with skip N2 metastasis on clinical stage IA NSCLC.
机构信息
Instituto do Cancer do Estado de São Paulo (ICESP), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Instituto do Cancer do Estado de São Paulo (ICESP), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
出版信息
Clinics (Sao Paulo). 2024 Mar 13;79:100334. doi: 10.1016/j.clinsp.2024.100334. eCollection 2024.
BACKGROUND
Lung lymphatic drainage occurs mainly through a peribronchial path, but it is hypothesized that visceral pleural invasion could alter this path. This study aims to investigate the association between visceral pleural invasion, node upstaging, and N2 skip metastasis and the impact on survival in a population of patients with non-small cell lung cancer of 3 cm or smaller.
METHODS
We retrospectively queried our institutional database of lung cancer resection for all patients with clinical stage IA NSCLC between June 2009 and June 2022. We collected baseline characteristics and clinical and pathological staging data. Patients were classified into two groups: The non-VPI group with negative visceral pleural invasion and the VPI group with positive. The primary results analyzed were the occurrence of nodal upstaging, skip N2 metastasis and recurrence.
RESULTS
There were 320 patients analyzed. 61.3 % were women; the median age was 65.4 years. The pleural invasion occurred in 44 patients (13.7 %). VPI group had larger nodules (2.3 vs. 1.7 cm; p < 0.0001), higher 18F-FDG uptake (7.4 vs. 3.4; p < 0.0001), and lymph-vascular invasion (35.7 % vs. 13.5 %, p = 0.001). Also, the VPI group had more nodal disease (25.6 % vs. 8.7 %; p = 0.001) and skip N2 metastasis (9.3 % vs. 1.8 %; p = 0.006). VPI was a statistically independent factor for skip N2 metastasis. Recurrence occurred in 17.2 % of the population. 5-year disease-free and overall survival were worse in the VPI group.
CONCLUSIONS
The visceral pleural invasion was an independent factor associated with N2 skip metastasis and had worse disease-free and overall survival.
背景
肺淋巴引流主要通过支气管周围途径进行，但有人假设内脏胸膜侵犯可能会改变这种途径。本研究旨在探讨非小细胞肺癌患者内脏胸膜侵犯、淋巴结分期升级和 N2 跳跃转移之间的关联，以及对 3cm 或更小的非小细胞肺癌患者生存的影响。
方法
我们回顾性地查询了我们机构的肺癌切除术数据库，以获取 2009 年 6 月至 2022 年 6 月期间所有临床分期为 IA 期非小细胞肺癌患者的资料。我们收集了基线特征和临床及病理分期数据。患者分为两组：内脏胸膜无侵犯的非 VPI 组和内脏胸膜有侵犯的 VPI 组。主要分析结果为淋巴结分期升级、跳跃性 N2 转移和复发的发生。
结果
共分析了 320 例患者。61.3%为女性；中位年龄为 65.4 岁。胸膜侵犯发生在 44 例患者中（13.7%）。VPI 组的结节较大（2.3 厘米比 1.7 厘米；p < 0.0001），18F-FDG 摄取较高（7.4 比 3.4；p < 0.0001），且淋巴管血管侵犯更为常见（35.7%比 13.5%；p = 0.001）。此外，VPI 组的淋巴结疾病更多（25.6%比 8.7%；p = 0.001），跳跃性 N2 转移也更常见（9.3%比 1.8%；p = 0.006）。VPI 是跳跃性 N2 转移的统计学独立因素。人群中 17.2%出现复发。VPI 组的 5 年无病生存率和总生存率较差。
结论
内脏胸膜侵犯是与 N2 跳跃转移相关的独立因素，与无病生存率和总生存率较差有关。
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