T-stage and range of resection of non-small cell lung cancer with directly invasion of the adjacent lobe_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Longfei , MEI Jiandong , LIU Chengwu , GUO Chenglin ,  LIU Lunxu

Department of Thoracic Surgery, West China Hospital, Sichuan University, Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, 610041, P.R.China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Non-small cell lung cancer; adjacent lobe invasion; neoplasm staging; prognosis; operation

DOI：

10.7507/1007-4848.201612017

Video：

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Objective To determine the most appropriate T-stage and surgical resection range of non-small cell lung cancer(NSCLC) with adjacent lobe invasion (ALI). Methods Fifty one NSCLC patients who were confirmed as direct ALI were divided into an ALI-T2 and an ALI-T3 group according to the eighth edition of TNM classification. Cases were matched by propensity score matching method at a ratio of 2∶1. The overall survival (OS), progression free survival (PFS), postoperative hospitalization, and postoperative complications among the groups were compared. Results Patients' characteristics were comparable among the groups. Three-year or 5-year survival rate in the ALI-T2 group, the single-lobe invasion T2 (SLI-T2) group, and the T3 (SLI-T3) group was 73.90% and 61.60%, 89.60% and 89.60%, 68.90% and 61.20%, respectively. The OS of SLI-T2 group was significantly higher than that of the ALI-T2 ( P=0.042) group and with similar survival in the SLI-T3 group( P=0.955). In the survival analysis of the ALI-T3 group, the 3-year or 5-year OS of the SLI-T3 group was 70.80% and 65.70%, respectively, while in the poorest prognosis ALI-T3 group was only 31.60% and 21.00% ( P=0.009), respectively. However, no statistical difference was detected between the ALI-T3 and SLI-T4 groups ( P=0.343). The PFS of the patients in the ALI-T3 group was closer to the SLI-T4 group level while lower than that of the SLI-T3 group, but the trend had not been confirmed by statistical analysis ( P ₁=0.071, P ₂=0.648). The OS and PFS did not differ between the patients undergoing a lobectomy plus wedge resection (LWR) and those undergoing a bilobectomy or pneumonectomy. Compared with a bilobectomy or pneumonectomy, LWR had distinct advantages in the postoperative hospital stay (6.90±3.11days vs. 9.23± 4.43 days, P=0.030), the postoperative duration of drainage (4.41±2.98 days vs. 6.50±4.11 days, P=0.041) and complication rates (4.00% vs. 31.58%, P=0.032). Conclusions We believe that T1-2 stage tumor invading adjacent lobe should be classified as T3 and ALI-T3 tumor should be revised as T4. Beside that, LWR could be considered as a reasonable surgical option for patients with lesser invasive depth (less than 2 cm) in the adjacent lobes.

Citation： ZHU Longfei, MEI Jiandong, LIU Chengwu, GUO Chenglin, LIU Lunxu. T-stage and range of resection of non-small cell lung cancer with directly invasion of the adjacent lobe. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 175-182. doi: 10.7507/1007-4848.201612017 Copy

1.	支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范(2015年版). 中华肿瘤杂志, 2015, 37(1): 67-78.
2.	Goldstraw P, Crowley J, Chansky K, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (Seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
3.	Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.
4.	杨浩贤, 侯雪, 林鹏, 等. 侵及邻肺叶的非小细胞肺癌与可手术的 T4 患者的术后生存比较. 中华医学杂志, 2009, 89(25): 1770-1773.
5.	Haam SJ, Park IK, Paik HC, et al. T-stage of non-small cell lung cancer directly invading an adjacent lobe. Eur J Cardiothorac Surg, 2012, 42(5): 807-810.
6.	何斌军, 崔健, 俞光懋. 跨叶型非小细胞肺癌的手术治疗分析. 浙江医学, 2009, 31(5): 709-710.
7.	Martini N, Melamed MR. Multiple primary lung cancers. Eur J Cardiothorac Surg, 1995, 9(5): 606-612.
8.	Morita R, Kaneko K, Nakamura S, et al. Should interlobar pleural invasion be categorized as T2 or T3? Haigan, 2002, 42(6): 583-587.
9.	Okada M, Tsubota N, Yoshimura M, et al. How should interlobar pleural invasion be classified? Prognosis of resected T3 non-small cell lung cancer. Ann Thorac Surg, 1999, 68(6): 2049-2052.
10.	Riquet M, Berna P, Arame A, et al. Lung cancer invading the fissure to the adjacent lobe: more a question of spreading mode than a staging problem. Eur J Cardiothorac Surg, 2012, 41(5): 1047-1051.
11.	Demir A, Gunluoglu MZ, Sansar D, et al. Staging and resection of lung cancer with minimal invasion of the adjacent lobe. Eur J Cardiothorac Surg, 2007, 32(6): 855-858.
12.	Yang HX, Hou X, Lin P, et al. Peripheral direct adjacent lobe invasion non-small cell lung cancer has a similar survival to that of parietal pleural invasion T3 disease. J Thorac Oncol, 2009, 4(11): 1342-1346.
13.	Dziedzic D, Rudzinski P, Langfort R, et al. Results of surgical treatment and impact on T staging of non-small-cell lung cancer adjacent lobe invasion. Eur J Cardiothorac Surg, 2016, 50(3): ezw110.
14.	Joshi V, McShane J, Page R, et al. Clinical upstaging of non-small cell lung cancer that extends across the fissure: implications for non-small cell lung cancer staging. Ann Thorac Surg, 2011, 91(2): 350-353.
15.	Leuzzi G, Cesario A, Cafarotti S, et al. Surgical treatment in patient with non-small-cell lung cancer with fissure involvement: anatomical versus nonanatomical resection. J Thorac Oncol, 2014, 9(1): 97-108.

1. 支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范(2015年版). 中华肿瘤杂志, 2015, 37(1): 67-78.
2. Goldstraw P, Crowley J, Chansky K, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (Seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
3. Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC lung cancer staging project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol, 2015, 10(7): 990-1003.
4. 杨浩贤, 侯雪, 林鹏, 等. 侵及邻肺叶的非小细胞肺癌与可手术的 T4 患者的术后生存比较. 中华医学杂志, 2009, 89(25): 1770-1773.
5. Haam SJ, Park IK, Paik HC, et al. T-stage of non-small cell lung cancer directly invading an adjacent lobe. Eur J Cardiothorac Surg, 2012, 42(5): 807-810.
6. 何斌军, 崔健, 俞光懋. 跨叶型非小细胞肺癌的手术治疗分析. 浙江医学, 2009, 31(5): 709-710.
7. Martini N, Melamed MR. Multiple primary lung cancers. Eur J Cardiothorac Surg, 1995, 9(5): 606-612.
8. Morita R, Kaneko K, Nakamura S, et al. Should interlobar pleural invasion be categorized as T2 or T3? Haigan, 2002, 42(6): 583-587.
9. Okada M, Tsubota N, Yoshimura M, et al. How should interlobar pleural invasion be classified? Prognosis of resected T3 non-small cell lung cancer. Ann Thorac Surg, 1999, 68(6): 2049-2052.
10. Riquet M, Berna P, Arame A, et al. Lung cancer invading the fissure to the adjacent lobe: more a question of spreading mode than a staging problem. Eur J Cardiothorac Surg, 2012, 41(5): 1047-1051.
11. Demir A, Gunluoglu MZ, Sansar D, et al. Staging and resection of lung cancer with minimal invasion of the adjacent lobe. Eur J Cardiothorac Surg, 2007, 32(6): 855-858.
12. Yang HX, Hou X, Lin P, et al. Peripheral direct adjacent lobe invasion non-small cell lung cancer has a similar survival to that of parietal pleural invasion T3 disease. J Thorac Oncol, 2009, 4(11): 1342-1346.
13. Dziedzic D, Rudzinski P, Langfort R, et al. Results of surgical treatment and impact on T staging of non-small-cell lung cancer adjacent lobe invasion. Eur J Cardiothorac Surg, 2016, 50(3): ezw110.
14. Joshi V, McShane J, Page R, et al. Clinical upstaging of non-small cell lung cancer that extends across the fissure: implications for non-small cell lung cancer staging. Ann Thorac Surg, 2011, 91(2): 350-353.
15. Leuzzi G, Cesario A, Cafarotti S, et al. Surgical treatment in patient with non-small-cell lung cancer with fissure involvement: anatomical versus nonanatomical resection. J Thorac Oncol, 2014, 9(1): 97-108.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

T-stage and range of resection of non-small cell lung cancer with directly invasion of the adjacent lobe

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