초록접수 현황
| 14F-107 | 포럼 발표 |
Pulmonary Resection in Non-small Nell Lung Lung Cancer with Unexpected Pleural Seeding
윤재광¹, 김미혜², 김형렬¹, 최세훈¹, 김용희¹, 김동관¹, 박승일¹
울산대학교 의과대학 서울아산병원 흉부외과학교실¹ , 차의과학대학교 분당차병원 알레르기 임상면역학교실²
Background : Curative surgery is not indicated for non-small cell lung cancer with pleural metastasis which is classified to stage IV (M1a). However, it is difficult to make decision for patients presumed resectable main tumor with localized pleural metastasis that is first detected during surgery.
Methods : A retrospective analysis was performed of 3975 consecutive patients, who underwent surgery for NSCLC from 2000 to 2011. Among them, 78 patients (2.0%) had unexpected pleural metastasis that first detected during surgery. Exploration with pleural biopsy was performed in 42 patients (exploration only group) and pulmonary resection including main tumor was performed in 36 patients (resection group, sublobar resection in 12, lobectomy in 21, pneumonectomy in 3 patients). Survival rate and cancer progression rate were estimated with the Kaplan-Meier method. Cox proportional hazards regression test was used to evaluate prognostic factor on survival.
Results : Adenocarcinoma was predominant histology either in exploration or resection group (88.1%, 86.1% respectively). Epidermal growth factor receptor (EGFR) expression among adenocarcinoma were positive in 22 (52.4%) and 21 (58.3%) patients in each group. Baseline characteristics including age, sex, co-morbidity, pulmonary function, clinical T / N state were not significantly different between two groups. The overall survival rates of exploration group was 41.1% in 3-year and 15.2 % in 5-year with a 33 months of median survival time (MST), whereas 3-year and 5-year survival rate of resection group were 66.7 and 42.7 % with a 52 months of MST (P=0.012). Local and regional cancer progression free survival rate showed significant difference (p<0.001 and p=0.029) between two groups, whereas distant metastasis free survival rate did not (p=0.957). In multivariable survival analysis, surgical resection was the only predominant prognostic factor (p=0.01).
Conclusion : Pulmonary resection including main tumor, regardless of resection extent, may help increasing long-term survival for non-small cell lung cancer when localized pleural metastasis is first detected during surgery, without a significant increase of the hospital mortality and morbidity.
Methods : A retrospective analysis was performed of 3975 consecutive patients, who underwent surgery for NSCLC from 2000 to 2011. Among them, 78 patients (2.0%) had unexpected pleural metastasis that first detected during surgery. Exploration with pleural biopsy was performed in 42 patients (exploration only group) and pulmonary resection including main tumor was performed in 36 patients (resection group, sublobar resection in 12, lobectomy in 21, pneumonectomy in 3 patients). Survival rate and cancer progression rate were estimated with the Kaplan-Meier method. Cox proportional hazards regression test was used to evaluate prognostic factor on survival.
Results : Adenocarcinoma was predominant histology either in exploration or resection group (88.1%, 86.1% respectively). Epidermal growth factor receptor (EGFR) expression among adenocarcinoma were positive in 22 (52.4%) and 21 (58.3%) patients in each group. Baseline characteristics including age, sex, co-morbidity, pulmonary function, clinical T / N state were not significantly different between two groups. The overall survival rates of exploration group was 41.1% in 3-year and 15.2 % in 5-year with a 33 months of median survival time (MST), whereas 3-year and 5-year survival rate of resection group were 66.7 and 42.7 % with a 52 months of MST (P=0.012). Local and regional cancer progression free survival rate showed significant difference (p<0.001 and p=0.029) between two groups, whereas distant metastasis free survival rate did not (p=0.957). In multivariable survival analysis, surgical resection was the only predominant prognostic factor (p=0.01).
Conclusion : Pulmonary resection including main tumor, regardless of resection extent, may help increasing long-term survival for non-small cell lung cancer when localized pleural metastasis is first detected during surgery, without a significant increase of the hospital mortality and morbidity.
책임저자: 김형렬
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 윤재광, Tel: 063-223-7695 , E-mail : janies@nate.com
