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Clinical Significance of Pleural Attachment and Indentation of Subsolid Nodule Lung Cancer

Cancer Research and Treatment 2019년 51권 4호 p.1540 ~ 1548
 ( Kim Hyung-Jun ) - Armed Forces Daegu Hospital Department of Internal Medicine

 ( Cho Jun-Yeun ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Lee Yeon-Joo ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Park Jong-Sun ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Cho Young-Jae ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Yoon Ho-Il ) - Seoul National University College of Medicine Department of Internal Medicine
 ( Chung Jin-Haeng ) - Seoul National University Bundang Hospital Department of Pathology
 ( Cho Suk-Ki ) - Seoul National University Bundang Hospital Department of Thoracic and Cardiovascular Surgery
 ( Kim Kwhan-Mien ) - Seoul National University Bundang Hospital Department of Thoracic and Cardiovascular Surgery
 ( Lee Kyung-Won ) - Seoul National University Bundang Hospital Department of Radiology
 ( Lee Jae-Ho ) - Seoul National University Bundang Hospital Department of Internal Medicine
 ( Lee Choon-Taek ) - Seoul National University Bundang Hospital Department of Internal Medicine

Abstract


Purpose: Lung cancers presenting as subsolid nodule commonly have peripheral location, making the cancer-pleura relationship noteworthy. We aimed to evaluate the effect of pleural attachment and/or indentation on visceral pleural invasion (VPI) and recurrence-free survival.

Materials and Methods: Patients who underwent curative resection of lung cancer as subsolid nodules from April 2007 to January 2016 were retrospectively evaluated. They were divided into four groups according to their relationship with the pleura. Clinical, radiographical, and pathological findings were analyzed.

Results: Among 404 patients with malignant subsolid nodule, 120 (29.7%) had neither pleural attachment nor indentation, 26 (6.4%) had attachment only, 117 (29.0%) had indentation only, and 141 (34.9%) had both. VPI was observed in nodules of 36 patients (8.9%), but absent in nonsolid nodules and in those without pleural attachment and/or indentation. Compared to subsolid nodules with concurrent pleural attachment and indentation, those with attachment only (odds ratio, 0.12; 95% confidence interval [CI], 0.02 to 0.98) and indentation only (odds ratio, 0.10; 95% CI, 0.03 to 0.31) revealed lower odds of VPI. On subgroup analysis, the size of the solid portion was associated with VPI among those with pleural attachment and indentation (p=0.021). Such high-risk features for VPI were associated with earlier lung cancer recurrence (adjusted hazard ratio, 3.31; 95% CI, 1.58 to 6.91).

Conclusion: Concurrent pleural attachment and indentation are risk factors for VPI, and the odds increase with larger solid portion in subsolid nodules. Considering the risk of recurrence, early surgical resection could be encouraged in these patients.

키워드

Lung neoplasms; Non-small-cell lung carcinoma; Pleura; Neoplasm invasiveness; Prognosis
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