脏层胸膜受侵对T2非小细胞肺癌预后的影响

目的评估T2非小细胞肺癌（non-small cell lung cancer,NSCLC）中脏层胸膜受侵（visceral pleural invasion,VPI）与其他临床病理特征的关系,评价其对预后的价值。方法行根治性手术切除的T2非小细胞肺癌的患者628例,其中ⅠB期（T2N0M0）265例,ⅡB期（T2N1M0）223例和ⅢA期（T2N2M0）140例。根据是否有VPI分成两组（Ⅰ组无受侵,Ⅱ组有受侵）。对两组病例肿瘤大小、组织学分类、是否有淋巴结的转移和生存率进行比较。结果Ⅱ组患者共有136例,占所有患者的21.7%,其中肿瘤直径≤3 cm 70例,肿瘤直径〉3 cm 66例。第Ⅰ组患者5年和10年生存率分别为53.7%和40.0%,而第Ⅱ组患者分别为25.7%和11.0%（P〈0.01）。IB期患者的生存率因肿瘤直径的不同而有显著不同,当考虑是否存在VPI时,这种差异更加显著。ⅡB和ⅢA期的患者不论肿瘤直径大小,两组患者的生存率差异无统计学意义。与其他组织型患者相比,腺癌患者更易出现VPI（38.4%）,VPI的患者更易出现淋巴结转移（14.7%N0,23.3%N13,2.1%N2;N2和N0相比较,P〈0.01;N2与N1比较,P〈0.01）。结论 VPI为T2非小细胞肺癌预后差的一项因素,它与更广泛的淋巴结转移和较低的生存率直接相关。

Prognostic study of visceral pleural invasion in T2 non-small cell lung cancer

Objective To assess the relationship between visceral pleural invasion(VPI) in T2 non-small cell lung cancer(NSCLC) and other clinicopathologic characteristics and to evaluate its significance as a prognostic factor.Methods 628 patients with T2 NSCLC underwent curative surgical resection in Miyun County Hospital and the First Hospital of Beijing University.The subjects included 265 patients with stage IB non-small cell lung cancer(T2N0M0),223 with stage IIB(T2N1M0),and 140 with stage ⅢA(T2N2M0).The patients were divided into two groups according to the VPI status(group Ⅰ without invation,group Ⅱ with invasion).Both groups were compared in tumor size,histology,associated lymph node involvement,and survival rates.Results VPI(group Ⅱ) was identified in 136 patients(21.7%) and was present in 70 patients with a tumor 3 cm or less and in 66 of patients with a tumor larger than 3 cm in size.5-and 10-year survival rates were 53.7% and 40.0% in group Ⅰ,and 25.7% and 11.0% in group Ⅱ,respectively(P<0.01).In patients of cancer at stage IB,the difference in survival rates was highly significant with the change of tumor size,especially so when visceral pleura was involved.However,at stage ⅡB and ⅢA,there was no difference in survival rates when visceral pleura was invaded regardless of the tumor size.Adenocarcinoma was significantly more frequently accompanied by VPI(38.4%) than the other histologic categories.VPI was associated with a higher frequency of lymph node involvement(14.7% for N0,23.3% for N1 and 32.1% for N2;N2 versus N0,P<0.01;N2 versus N1,P<0.01).Conclusions VPI is a factor of poor prognosis in T2 NSCLC and is correlated with more extensive lymph node involvement and a decreased survival rate.Patients with VPI should be closely followed up.