Shimosato Y, Suzuki A, Hashimoto T, Nishiwaki Y, Kodama T, Yoneyama T, Kameya T
Am J Surg Pathol. 1980 Aug;4(4):365-73. doi: 10.1097/00000478-198008000-00005.
Peripheral lung cancers frequently possess a fibrotic focus or scar in their center or beneath the pleura. We reexamined 58 cases of peripheral lung cancer of less than 3 cm in diameter (48 adenocarcinomas, two large cell carcinomas and eight squamous cell carcinomas) which were removed surgically between June 1962 and July 1973. Analyses of the cases revealed that in adenocarcinoma with increased collagenization or hyalinization in the fibrotic focus, the degree of pleural invasion and incidence of lymph node metastasis and blood vessel invasion were greater and thus the prognosis of the patient was poorer than in cases with no or slight collagenization. The results also indicate that the characteristics of the central fibrotic focus are probably more important than the size of the tumor for estimating the prognosis of patients with peripheral adenocarcinoma of less than 3 cm in diameter. The same might be said of peripheral large-cell carcinoma. However, the prognostic importance of the fibrotic focus was not confirmed in cases of peripheral squamous-cell carcinoma. Although the central or subpleural scar has long been the basis of the scar cancer concept, alternate explanations were considered, namely, that scar formation occurred along with tumor development, rather than before, in the case of adenocarcinomas.
周围型肺癌常常在其中心或胸膜下有纤维化灶或瘢痕。我们重新检查了1962年6月至1973年7月间手术切除的58例直径小于3 cm的周围型肺癌（48例腺癌、2例大细胞癌和8例鳞状细胞癌）。对这些病例的分析显示，在纤维化灶中胶原化或玻璃样变增加的腺癌中，胸膜侵犯程度、淋巴结转移发生率和血管侵犯情况比无胶原化或轻度胶原化的病例更严重，因此患者的预后更差。结果还表明，对于评估直径小于3 cm的周围型腺癌患者的预后，中央纤维化灶的特征可能比肿瘤大小更重要。周围型大细胞癌可能也是如此。然而，在周围型鳞状细胞癌病例中，纤维化灶的预后重要性未得到证实。尽管长期以来中央或胸膜下瘢痕一直是瘢痕癌概念的基础，但也考虑了其他解释，即在腺癌病例中，瘢痕形成是与肿瘤发展同时发生的，而不是在肿瘤发展之前。
