Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Visceral Pleural Invasion as a Prognostic Factor for Recurrence in Resected IB Non-small Cell Lung Cancer

완전 절제된 IB 비소세포암에서 재발의 예후인자로의 장측늑막 침범

  • Kim, Seok (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic Medical Center) ;
  • Park, Ki-Sung (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic Medical Center) ;
  • Kum, Yoon-Seup (Department of Pathology, Daegu Catholic Medical Center) ;
  • Lee, Sub (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic Medical Center) ;
  • Bae, Chi-Hoon (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic Medical Center) ;
  • Hyun, Dae-Sung (Department of Internal Medicine, Daegu Catholic Medical Center)
  • 김석 (대구가톨릭대학교병원 흉부외과) ;
  • 박기성 (대구가톨릭대학교병원 흉부외과) ;
  • 금윤섭 (대구가톨릭대학교병원 병리과) ;
  • 이섭 (대구가톨릭대학교병원 흉부외과) ;
  • 배지훈 (대구가톨릭대학교병원 흉부외과) ;
  • 현대성 (대구가톨리대학교병원 내과)
  • Published : 2009.10.05
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Abstract

Background: Several trials have reported on whether adjuvant chemotherapy for resected stage IB non-small cell lung cancer is needed. The aim of our study was to investigate prognostic factors for recurrence to help identify patients who should receive adjuvant chemotherapy. Material and Method: We reviewed the cases of 48 stage IB non-small cell lung cancer patients between 1997 and 2006. Disease-free survival and overall survival rates were calculated by the Kaplan-Meier method. Univariate analysis was performed with the log rank test and multivariate analysis was done using Cox's proportional hazard model. Result: The median follow-up time was 48 months. The overall survival rate was 55.9%, and the disease-free survival rate was 48.6%. Of 8 variables, two factors, visceral pleural invasion and Iymphovascular invasion, were prognostic factors of disease-free survival (univariate analysis). Visceral pleural invasion was a significant prognostic factor in multivariate analysis, and overall survival in com-pared one or more variable such as visceral pleural invasion or, and lymphovascular invasion with the other variables. Conclusion: Visceral pleural invasion was identified as a poor prognostic factor and it may help select which patients will benefit from adjuvant chemotherapy in addition to more comprehensive follow-up.

배경: 완전 절제된 IB 비소세포암에서 항암요법의 반드시 필요한가에 대한 여러 보고가 있다. 그래서 본 연구는 완전 절제된 IB 비소세포암 환자에서 재발에 관여하는 예후인자를 찾고 항암요법의 필요성을 알아보았다. 대상 및 방법: 1997년부터 2006년까지 모두 48명의 환자를 후향적으로 조사하였다. 전체생존율과 무병생존율을 위해 Kaplan-Meier method를 사용하였고 단변량 분석은 log rank, 다변량 분석은 Cox 회귀모형을 사용하였다. 결과: 추적중앙값은 48개월, 5년 전체생존율은 55.9%, 5년 무병생존율은 48.6%였다. 단변량 분석에서 장측늑막과 임파혈관 침범이 재발에 유의한 인자였고, 다변량분석에서는 장측늑막침범이 예후인자였다. 또한 장측늑막, 임파혈관 침범 중 한 개 이상의 경우, 없는 경우와 비교하여 전체 생존율에서 의미 있는 차이가 있었다. 결론: 장측늑막침범은 재발 및 생존에 관여하는 불량한 예후인자이며, 항암요법이 필요한 환자를 선택할 때 도움 되는 인자로 생각된다.

Keywords

References

  1. Martini N, Bains MS, Burt ME, et al. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg 1995;109:120-9 https://doi.org/10.1016/S0022-5223(95)70427-2
  2. Ravdin PM, Davis G. Prognosis of patients with resected non-small cell lung cancer: impact of clinical and pathologic variables. Lung Cancer 2006;52:207-12 https://doi.org/10.1016/j.lungcan.2006.01.016
  3. International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med 2004;350:351-60 https://doi.org/10.1056/NEJMoa031644
  4. Winton T, Livingston R, Johnson D, et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. N Engl J Med 2005;352:2589-97 https://doi.org/10.1056/NEJMoa043623
  5. Strauss GMH, Maddaus JE, Johnstone MA, et al. Adjuvant chemotherapy in stage IB non-small cell lung cancer (NSCLC): update of cancer and leukemia group B (CALGB) protocol 9633. J Clin Oncol 2006;24(suppl):7007
  6. Scagliotti GV, Fossati R, Torri V, et al. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst 2003; 95:1453-61 https://doi.org/10.1093/jnci/djg059
  7. Harpole DH Jr, Herndon JE 2nd, Young WG Jr, et al. Stage I nonsmall cell lung cancer: a multivariate analysis of treatment methods and patterns of recurrence. Cancer 1995;76: 787-96 https://doi.org/10.1002/1097-0142(19950901)76:5<787::AID-CNCR2820760512>3.0.CO;2-Q
  8. Sawyer TE, Bonner JA, Gould PM, et al. Patients with stage I non-small cell lung carcinoma at postoperative risk for local recurrence, distant metastasis, and death: implications related to the design of clinical trials. Int J Radiat Oncol Biol Phys 1999;45:315-21
  9. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710-7 https://doi.org/10.1378/chest.111.6.1710
  10. Goya T, Asamura H, Yoshimura H, et al. Prognosis of 6644 resected non-small cell lung cancers in Japan. A Japanese lung cancer registry study. Lung Cancer 2005;50:227-34 https://doi.org/10.1016/j.lungcan.2005.05.021
  11. Manac’h D, Riquet M, Medioni J, et al. Visceral pleura invasion by non-small cell lung cancer: an underrated bad prognostic factor. Ann Thorac Surg 2001;71:1088-93 https://doi.org/10.1016/S0003-4975(00)02649-7
  12. Padilla J, Calvo V, Penalver JC, et al. Survival and risk model for stage IB non-small cell lung cancer. Lung Cancer 2002;36:43-8 https://doi.org/10.1016/S0169-5002(01)00450-0
  13. Shimizu K, Yoshida J, Nagai K, et al. Visceral pleural invasion is as invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg 2005;130:160-5 https://doi.org/10.1016/j.jtcvs.2004.11.021
  14. Suzuki K, Nagai K, Yoshida J, et al. Conventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinoma. Cancer 1999;86:1976-84 https://doi.org/10.1002/(SICI)1097-0142(19991115)86:10<1976::AID-CNCR14>3.0.CO;2-I
  15. Read RC, Yoder G, Schafer RC. Survival after conservative resection for T1N0M0 non-small cell lung cancer. Ann Thorac Surg 1990;49:349-54
  16. Thomas PA, Piantadosi S, and the Lung Cancer Study Group. Postoperative T1N0 non-small cell lung cancer. Squamous versus non-squamous recurrence. J Thorac Cardiovasc Surg 1987;94:349-54
  17. Kurokawa T, Matsuno Y, Noguchi M, Mizuno S, Shimosato Y. Surgically curable "early" adenocarcinoma in the periphery of the lung. Am J Surg Pathol 1994;18:431-8 https://doi.org/10.1097/00000478-199405000-00001