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KMID : 0939920190510041540
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대한암학회지
2019 Volume.51 No. 4 p.1540 ~ p.1548
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Clinical Significance of Pleural Attachment and Indentation of Subsolid Nodule Lung Cancer
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Kim Hyung-Jun
Cho Jun-Yeun
Lee Yeon-Joo
Park Jong-Sun
Cho Young-Jae
Yoon Ho-Il
Chung Jin-Haeng
Cho Suk-Ki
Kim Kwhan-Mien
Lee Kyung-Won
Lee Jae-Ho
Lee Choon-Taek
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Abstract
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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.
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KEYWORD
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Lung neoplasms, Non-small-cell lung carcinoma, Pleura, Neoplasm invasiveness, Prognosis
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