Lymphatic invasion is a cause of local recurrence after wedge resection of primary lung cancer
Lymphatic invasion is a cause of local recurrence after wedge resection of primary lung cancer
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DOI：
10.1007/s11748-019-01095-6
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发表时间：
2019-10-01
影响因子：
1.2
通讯作者：
Yokomise, Hiroyasu
中科院分区：
文献类型：
--
作者：
Matsuura, Natsumi;Go, Tetsuhiko;Yokomise, Hiroyasu
目的 楔形切除术获得足够的手术切缘后，手术切缘未发现肿瘤残留的病理证据，相当一部分患者出现局部复发。我们研究了胸膜下淋巴流量与局部复发之间的相关性。方法回顾性分析2006年1月至2014年12月期间在我院接受楔形切除术的144例非小细胞肺癌患者的病历。结果术后复发36例（25%）。其中 29 名患者（80.5%）出现局部复发。淋巴管侵犯 (LVI) 患者中所有复发和局部复发的比例显着较高 (p < 0.0001)。有 LVI 的患者的无复发生存率 (24.8%) 显着低于无 LVI 的患者 (80.2%, p < 0.0001)。多变量逻辑回归分析证明 LVI（比值比 = 6.420，p = 0.0009）是局部复发的重要预测因子。结论瘤内淋巴管侵犯是局部复发的主要原因。尽管我们应尽可能采取根治性手术，但当有限手术是唯一选择时，即使是早期出现淋巴侵犯的患者也可能需要考虑术后辅助治疗。
Objective After securing a sufficient surgical margin at wedge resection and finding no pathologic evidence of residual tumor at the surgical margin, a considerable number of patients develop local recurrence. We investigated the correlation between sub-pleural lymphatic flow and local recurrence. Methods We retrospectively reviewed the medical records of 144 non-small cell lung cancer patients who underwent wedge resection between January 2006 and December 2014 at our institution. Results Postoperative recurrence was observed in 36 patients (25%). Of these, local recurrence was observed in 29 patients (80.5%). The proportion of all recurrence and local recurrence were significantly higher among patients with lymphatic vessel invasion (LVI) (p < 0.0001). Recurrence-free survival rate was significantly lower in patients with LVI (24.8%) than in patients without LVI (80.2%, p < 0.0001). Multivariate logistic regression analysis demonstrated LVI (odds ratio = 6.420, p = 0.0009) as a significant predictor of local recurrence. Conclusions Intratumoral lymphatic invasion represents a major cause of local recurrence. Although we should aim for radical surgery whenever possible, when limited surgery is the only option, postoperative adjuvant treatment may need to be considered for patients showing lymphatic invasion even at an early stage.