胸膜播種, 悪性胸水を伴う肺癌手術症例の検討D, E因子の亜分類の意義について  [in Japanese] Prognosis of lung cancer patients with pleural dissemination and malignant pleural effusion detected at thoracotomy  [in Japanese]

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Abstract

胸膜播種,悪性胸水を伴った原発性肺癌手術症例98例を対象とし,病変切除の意義および現行の肺癌取扱い規約に定義されているD・E因子亜分類の予後因子としての意義を検討した.胸膜播種のみの症例は79例,悪性胸水のみが3例,両方を認めた症例は16例であった.98例全体の3年生存率は33.8%で生存期間中央値は2.1年であった.組織型は約8割が腺癌であった.29例の切除群(姑息的または根治目的)と69例の非切除群の生存率に有意差を認めなかった(p=0.36).また,D1群(n=30)とD2群(n=65)の生存率にも有意差を認めなかった(p=0.79).胸膜播種,悪性胸水を伴った原発性肺癌に対する病変の切除は予後改善には寄与しないこと,D因子は予後因子として機能していないことが示された.またE因子については,E2およびEp,Epnに亜分類された症例は殆ど存在せず,胸水の有無と細胞診の情報のみで十分であると考えられた.

The purpose of this study was to evaluate the prognosis of primary lung cancer patients with pleural dissemination or malignant pleural effusion who underwent surgical intervention. We also evaluated the significance of the subclassification system of pleural dissemination (D factor) and malignant pleural effusion (E factor) in the current Japanese lung cancer staging system. Between 1992 and 2006, a total of 2,947 primary lung cancer patients underwent surgical intervention at our institution. Among them, 98 patients who had pathologically or cytologically confirmed malignant pleural effusion and/or pleural dissemination were enrolled in this study. The clinicopathological factors of each patient were reviewed, and the prognosis was evaluated retrospectively. In 98 patients, 79 had only pleural dissemination, 3 had only malignant pleural effusion, and 16 had both. Adenocarcinoma was the predominant histologic type, estimated at a rate of almost 80%. Resection of the main tumor (palliative resection or grossly-complete resection) was performed in 29 patients, and the remaining 69 patients underwent exploratory thoracotomy. The 3-year overall survival rate and median overall survival time of all 98 patients were 33.8% and 2.1 years, respectively. The overall survival rate of the 29 resected cases (3-year: 25.9%) was not significantly different from that of the 69 unresected cases (3-year: 37.8%, <I>p</I>=0.35). According to the D subclassification, the overall survival rate of the 30 D1 cases (3-year: 34.9%) was not different from that of the 65 D2 cases (3-year: 35.4%, <I>p</I>=0.79). Among 19 patients with malignant pleural effusion, few patients were subclassified into E2, and no patients were subclassified into Ep and Epn. Our present study indicated that resection of the main tumor does not improve the outcome of patients with malignant pleural effusion and/or pleural dissemination. Furthermore, the current D subclassification does not work as a prognostic indicator. With regard to E subclassification, information on the presence and cytological diagnosis of pleural effusion is sufficient as a prognostic factor.

Journal

The Journal of the Japanese Association for Chest Surgery  

The Journal of the Japanese Association for Chest Surgery 24(4), 664-669, 2010-05-15 

The Japanese Association for Chest Surgery

References:  14

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Codes

  • NII Article ID (NAID) :
    10026475542
  • NII NACSIS-CAT ID (NCID) :
    AN10467885
  • Text Lang :
    JPN
  • Article Type :
    ART
  • ISSN :
    09190945
  • Databases :
    CJP  J-STAGE