• Journal of Chest Surgery
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• 제57권2호
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• pp.136-144
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• 2024

Background: Early non-small cell lung cancer (NSCLC) that abuts adjacent structures requires careful evaluation due to its potential impact on postoperative outcomes and prognosis. We examined stage I NSCLC with invasion into adjacent structures, focusing on the prognostic implications after curative surgical resection. Methods: We retrospectively analyzed the records of 796 patients who underwent curative surgical resection for pathologic stage IA/IB NSCLC (i.e., visceral pleural invasion only) at a single center from 2008 to 2017. Patients were classified based on tumor abutment and then reclassified by the presence of visceral pleural invasion. Clinical characteristics, pathological features, and survival rates were compared. Results: The study included 181 patients with abutting NSCLC (22.7% of all participants) and 615 with non-abutting tumors (77.3%). Those with tumor abutment exhibited higher rates of non-adenocarcinoma (26.5% vs. 9.9%, p<0.01) and visceral/lymphatic/vascular invasion (30.4%/33.1%/12.7% vs. 8.5%/22.4%/5.7%, respectively; p<0.01) compared to those without abutment. Multivariable analysis identified lymphatic invasion and male sex as risk factors for overall survival (OS) and disease-free survival (DFS) in stage I NSCLC measuring 3 cm or smaller. Age, smoking history, vascular invasion, and recurrence emerged as risk factors for OS, whereas the presence of non-pure ground-glass opacity was a risk factor for DFS. Conclusion: NSCLC lesions 3 cm or smaller that abut adjacent structures present higher rates of various risk factors than non-abutting lesions, necessitating evaluation of tumor invasion into adjacent structures and lymph node metastasis. In isolation, however, the presence of tumor abutment without visceral pleural invasion does not constitute a risk factor.

• Journal of Chest Surgery
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• 제42권5호
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• pp.610-614
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• 2009

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.

• Tuberculosis and Respiratory Diseases
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• 제47권1호
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• pp.66-76
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• 1999

연구배경: 비소세포성 폐암에서 장측 흉막 침범은 CT로 평가된 적이 드물고, CT상 기관지혈관속 비후는 병리적으로 확인되는 적이 드물다. 이들 침범양상이 국소적 재발과 원격 재발 그리고 생존에 영향을 미치는 요인을 분석하고자한다. 방법: 1986년에서 1995년까지 NSCLC로 근치적 수술을 시행 받은 434예 중에서 적어도 18개월에서 최장 103개월까지 추적 관찰하여 국소적 재발과 원격 전이 그리고 생존 여부를 확인한 81예를 대상으로 하였다. 장측 흉막 침범 여부 그리고 동측 폐엽 기관지혈관속 비후 여부에 따른 국소적 재발과 원격 전이 그리고 생존에 미치는 영향을 분석하였다. 장측 흉막 침범의 평가를 위해 고해상도 전산화 단충 촬영을 시행하고, 흉막이나 폐열에 근접한 종괴가 있었던 32예를 가지고 장측 흉막 침범 여부에 대한 고해상도 전산화단층촬영의 유용성을 알아보았다. 결과: CT상 종괴가 폐열을 건너간 경우에 장측 흉막 침범 진단에 대한 각각 높은 양성, 음성 예측도를 보였다(100%, 100%). 종괴와 면한 열이 종괴와 붙어 있거나 누르고 있는 경우 중에 불규칙한 변연을 보이는 2예에서는 모두 장측 흉막 침범을 보였다. 병리학적으로 확인된 장층 흉막 침범 여부는 국소적 재발에 유의한 차이가 있었고 (p<.05), 생존율에도 차이가 있었다(p<.05). CT상 동측 폐엽 기관지혈관속 비후 여부는 국소적 재발과 원격재발 모두 유의한 차이가 없었으나, 생존율에는 유의한 차이가 있었다(p<.05). 결론: 창측 흉막 침범 여부 그리고 CT상 동측 폐엽 기관지 혈관속 비후 여부는 재발와 생존에 영향을 미치는 요인으로 확인되었다. 따라서 장측 흉막 침범에 대한 CT의 분석과 기관지혈관속 비후의 병리학적 확인은 폐암환자의 예후 추정에 중요하다.

• Korean Journal of Radiology
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• 제22권5호
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• pp.829-839
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• 2021

Objective: To compare the diagnostic performance of contrast-enhanced radial T1-weighted gradient-echo 3-tesla (3T) magnetic resonance imaging (MRI) and computed tomography (CT) for the detection of visceral pleural surface invasion (VPSI). Visceral pleural invasion by non-small-cell lung cancer (NSCLC) can be classified into two types: PL1 (without VPSI), invasion of the elastic layer of the visceral pleura without reaching the visceral pleural surface, and PL2 (with VPSI), full invasion of the visceral pleura. Materials and Methods: Thirty-three patients with pathologically confirmed VPSI by NSCLC were retrospectively reviewed. Multidetector CT and contrast-enhanced 3T MRI with a free-breathing radial three-dimensional fat-suppressed volumetric interpolated breath-hold examination (VIBE) pulse sequence were compared in terms of the length of contact, angle of mass margin, and arch distance-to-maximum tumor diameter ratio. Supplemental evaluation of the tumor-pleura interface (smooth versus irregular) could only be performed with MRI (not discernible on CT). Results: At the tumor-pleura interface, radial VIBE MRI revealed a smooth margin in 20 of 21 patients without VPSI and an irregular margin in 10 of 12 patients with VPSI, yielding an accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and F-score for VPSI detection of 91%, 83%, 95%, 91%, 91%, and 87%, respectively. The McNemar test and receiver operating characteristics curve analysis revealed no significant differences between the diagnostic accuracies of CT and MRI for evaluating the contact length, angle of mass margin, or arch distance-to-maximum tumor diameter ratio as predictors of VPSI. Conclusion: The diagnostic performance of contrast-enhanced radial T1-weighted gradient-echo 3T MRI and CT were equal in terms of the contact length, angle of mass margin, and arch distance-to-maximum tumor diameter ratio. The advantage of MRI is its clear depiction of the tumor-pleura interface margin, facilitating VPSI detection.

• Journal of Chest Surgery
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• 제57권1호
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• pp.44-52
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• 2024

Background: Visceral pleural invasion (VPI) is a poor prognostic factor that contributes to the upstaging of early lung cancers. However, the preoperative assessment of VPI presents challenges. This study was conducted to examine intraoperative pleural carcinoembryonic antigen (pCEA) level and maximum standardized uptake value (SUVmax) as predictive markers of VPI in patients with clinical T1N0M0 lung adenocarcinoma. Methods: A retrospective review was conducted of the medical records of 613 patients who underwent intraoperative pCEA sampling and lung resection for non-small cell lung cancer. Of these, 390 individuals with clinical stage I adenocarcinoma and tumors ≤30 mm were included. Based on computed tomography findings, these patients were divided into pleural contact (n=186) and non-pleural contact (n=204) groups. A receiver operating characteristic (ROC) curve was constructed to analyze the association between pCEA and SUVmax in relation to VPI. Additionally, logistic regression analysis was performed to evaluate risk factors for VPI in each group. Results: ROC curve analysis revealed that pCEA level greater than 2.565 ng/mL (area under the curve [AUC]=0.751) and SUVmax above 4.25 (AUC=0.801) were highly predictive of VPI in patients exhibiting pleural contact. Based on multivariable analysis, pCEA (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.14-7.87; p=0.026) and SUVmax (OR, 5.25; 95% CI, 1.90-14.50; p=0.001) were significant risk factors for VPI in the pleural contact group. Conclusion: In patients with clinical stage I lung adenocarcinoma exhibiting pleural contact, pCEA and SUVmax are potential predictive indicators of VPI. These markers may be helpful in planning for lung cancer surgery.

• Journal of Chest Surgery
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• 제24권6호
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• pp.595-604
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• 1991

Pleural mesothelioma is usually divided into two forms of localized and diffuse type. Localized pleural fibrous mesothelioma is uncommon mesodermal neoplasm, which may occurs in both sexes and at the age of 50 years. This type of mesothelioma is usually asymptomatic and detected on routine chest X-ray and made fibrous tissue and shows of collagen fibers microscopically. Most localized fibrous mesothelioma arises from the visceral pleura and is well encapsulated and pedunculated mass. CT findings included well delineated, often lobulated, non-calcified soft tissue masses in close relation to a pleural space, associated pleural thickening, and absence of chest wall invasion and a peripheral or fissure location. Three cases of localized pleural fibrous mesothelioma diagnosed by resectional surgery were reported with the review of literature.

• Journal of Chest Surgery
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• 제52권3호
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• pp.131-140
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• 2019

Background: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. Methods: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. Results: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. Conclusion: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6287-6292
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• 2013

Background: Surgery is the only curative treatment for operable non-small lung cancer (NSCLC) and the importance of adjuvant chemotherapy for stage IB patients is unclear. Herein, we evaluated prognostic factors for survival and factors related with adjuvant treatment decisions for stage I and IIA NSCLC patients without lymph node metastasis. Materials and Methods: We retrospectively analyzed 302 patients who had undergone curative surgery for prognostic factors regarding survival and clinicopathological factors related to adjuvant chemotherapy. Results: Nearly 90% of the patients underwent lobectomy or pneumonectomy with mediastinal lymph node resection. For the others, wedge resection were performed. The patients were diagnosed as stage IA in 35%, IB in 49% and IIA in 17%. Histopathological type (p=0.02), tumor diameter (p=0.01) and stage (p<0.001) were found to be related to adjuvant chemotherapy decisions, while operation type, lypmhovascular invasion (LVI), grade and the presence of recurrence were important factors in predicting overall survival (OS), and operation type, tumor size greater than 4 cm, T stage, LVI, and visceral pleural invasion were related with disease free survival (DFS). Multivariate analysis showed operation type (p<0.001, hazard ratio (HR):1.91) and the presence of recurrence (p<0.001, HR:0.007) were independent prognostic factors for OS, as well visceral pleural invasion (p=0.01, HR:0.57) and LVI (p=0.004, HR:0.57) for DFS. Conclusions: Although adjuvant chemotherapy is standard for early stage lymph node positive NSCLC, it has less clear importance in stage I and IIA patients without lymph node metastasis.

• Journal of Chest Surgery
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• 제31권10호
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• pp.982-987
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• 1998

연세대학교 의과대학 신촌세브란스병원 흉부외과에서는 1990년 1월부터 1996년 12월까지 원발성 폐암으로 폐절제술을 시행한 환자중 병리학적 병기가 제 1기인 146명을 대상으로 분석 하였다. 이중 남자는 115명, 여자가 31명이었고 나이는 27세에서 79세까지로 평균 58.9세 이었다. 세포병리학적 분류로 상피세포암이 7 2례(49.3%), 선암이 45례(30.8%)로 대부분 이었고, 수술은 전례에서 폐절제술과 종격동 임파절 박리술을 시행하였으며 폐엽 절제술이 96례(65.7%), 전폐 절제술이 48례(32.9%)이었다. 수술사망은 5례(3.4%), 합병증은 24례(16.5%)에서 발생하였다. 5년 생존율은 64.1% 이었으며 평균 생존기간은 66.5개월이었다. 예후인자별 분석에서 수술범위(p=0.1165), 세포형(p=0.8893)에 따른 생존율의 차이는 없었으며, 장측늑 막의 침윤 여부(p=0.0079), T1과 T2(p=0.0462), 선암에서 종양의 크기(>=5 cm)(p=0.0472)에 따른 생존율은 의미있는 차이를 보였다. 수술후 재발은 47례(33.3%)에서 발생 하였고, 이중 국소재발이 9례, 원격전이가 38례 이었다. 재발된 례중 대부분인 44례(93.7%)가 T2병변에서 재발되었고 3례(6.4%)만이 T1병변에서 재 발 되었다. 원격전이가 일어난 부위로는 반대편 폐가 13례로 가장 많았고 뇌 12례, 골 10례등 이었다. 결 론으로 장측늑막의 침윤, T2 병변, 선암에서 크기가 5 cm 이상인 경우에는 제 1기 폐암이라 할 지라도 수 술후 보조치료를 고려해 볼 수 있으리라 사료되었다.

• Journal of Chest Surgery
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• 제45권2호
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• pp.101-109
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• 2012

Background: A better understanding of the histopathology and molecular biology of lung cancer might improve our capability to predict the outcome for any individual patient. The purpose of this study was to evaluate several histopathologic and molecular markers in order to assess their prognostic value in stage I non-small cell lung cancer. Materials and Methods: One hundred ten patients at the Kyungpook National University Hospital were enrolled in the study. Histopathologic factors and molecular markers were selected. Results: Univariate analysis showed that the T stage, differentiation, visceral pleural invasion, and survivin expression were significantly associated with recurrence. Multivariate analysis demonstrated that differentiation and survivin overexpression emerged as independent prognostic factors of recurrence. Conclusion: In resected stage I non-small cell lung cancer, poor differentiation and survivin overexpression have been identified as independent predictors of poor disease-free survival.