Prognostic impact of uncertain parietal pleural invasion at adhesion sites in non-small cell lung cancer patients
Prognostic impact of uncertain parietal pleural invasion at adhesion sites in non-small cell lung cancer patients
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DOI：
10.1016/j.lungcan.2017.03.002
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发表时间：
2017-06-01
期刊：
影响因子：
5.3
通讯作者：
Satoh, Yukitoshi
中科院分区：
文献类型：
--
作者：
Mikubo, Masashi;Nakashima, Hiroyasu;Satoh, Yukitoshi
目的：胸膜侵犯已被认为是非小细胞肺癌（NSCLC）的重要不良预后因素，因此需要准确的评估。然而，当肿瘤周围脏层胸膜与壁层胸膜粘连，壁层胸膜结构因炎症而被破坏而无法识别时，往往难以准确评估胸膜侵犯，T分期的分类也不清楚。为了帮助分类，我们将这种状态定义为 pl1-3，并研究了 pl1-3 状态对 NSCLC 的预后影响。材料和方法：我们回顾性检查了 929 例接受根治性手术切除的 NSCLC 患者的临床病理特征和预后。 p1-3状态定义为侵犯超出脏层胸膜弹性层（pl1或更高），但显示不清楚的壁层胸膜侵犯。我们比较了 pl1-3 状态 NSCLC 患者与其他胸膜侵犯状态患者的预后。结果：31 名患者 (3%) 具有 pl1-3 状态。 pl1-3患者的5年总生存率为58.9%，预后明显差于pl1（p = 0.04）。在 pN0 队列中，pl1-3 疾病的预后明显比 pl1 和 pI2 疾病差（分别为 p = 0.01 和 0.04），并且与 pl3 疾病的预后相似。此外，在多变量分析中调整其他预后因素后也观察到类似的关系。在pl1-3和pN0患者中，11例（46%）出现复发（9例出现远处转移，1例出现局部复发，1例两者兼而有之）。虽然接受辅助治疗的 pl1-3 患者比例与 T3 患者相似，但接受口服替加氟尿嘧啶治疗的个体多于静脉化疗。结论：这些结果表明 pl1-3 患者可以采用与 T3 和 pl3 疾病患者相同的方式进行治疗。这些结果可能为术后化疗期间的治疗决策提供信息。 (C) 2017 Elsevier B.V. 保留所有权利。
Objectives: Pleural invasion has been recognized as an important negative prognostic factor in non-small cell lung cancer (NSCLC), and therefore, accurate evaluation is required. However, when the visceral pleura adheres to the parietal pleura around a tumor and parietal pleural structures are destroyed and unrecognizable as a result of inflammation, it is often difficult to accurately evaluate pleural invasion, and classification of the T stage is unclear. To aid in categorization, we defined this status as pl1-3 and investigated the prognostic impact of the pl1-3 status on NSCLC.Materials and methods: We retrospectively examined the clinicopathological characteristics and prognoses of 929 NSCLC patients who underwent curative surgical resection. The p1-3 status was defined as invasion beyond the elastic layer of the visceral pleura (pl1 or higher) but showing unclear parietal pleural invasion. We compared the prognoses of pl1-3 status NSCLC patients with that of patients with other pleural invasion statuses.Results: Thirty-one patients (3%) had a pl1-3 status. The 5-year overall survival rate for pl1-3 patients was 58.9%, and the prognosis was significantly worse than pl1 (p = 0.04). In pN0 cohort, pl1-3 disease had a significantly worse prognosis than pl1 and pI2 diseases (p = 0.01 and 0.04, respectively) and a similar prognosis to pl3 disease. Furthermore, similar relationships were also observed after adjusting for other prognostic factors in multivariate analysis. Among the pl1-3 and pN0 patients, 11 (46%) developed recurrences (9 patients had distant metastasis, one had local recurrence, and one had both). Although the proportion of pl1-3 patients who underwent adjuvant therapy was similar to that of T3 patients, more individuals received oral tegafur-uracil treatment than intravenous chemotherapy.Conclusion: These results indicate that pl1-3 patients can be managed in the same manner as patients with T3 and pl3 disease. These results may be informative for treatment decisions during postoperative chemotherapy. (C) 2017 Elsevier B.V. All rights reserved.