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The prognostic impact of the mediastinal fat tissue invasion in patients with non-small cell lung cancer

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Abstract

Background

The prognosis of the mediastinal fat tissue invasion in non-small cell lung cancer (NSCLC) patients has not yet been clearly defined. The present study aimed to investigate the prognostic impact of the mediastinal fat tissue invasion in NSCLC patients.

Method

We analyzed 36 patients who were found mediastinal fat tissue invasion by pathological evaluation (mediastinal fat group) and 248 patients who were classified as T4-NSCLC according to the 8th TNM classification (T4 group; invasion of other mediastinal structures in 78 patients, ipsilateral different lobe satellite pulmonary nodule in 32 patients, and tumor diameter > 7 cm in 138 patients).

Result

Resection was regarded as complete (R0) in 255 patients (89.7%). Mediastinal fat group showed significantly higher incidence of incomplete resection (R1) and more left-sided tumors than the T4 group (p = 0.01, and p = 0.002, respectively). The survival was better in T4 group than mediastinal fat group (median 57 months versus 31 months), although it was not significant (p = 0.205). Even when only N0/1 or R0 patients were analyzed, the survival was not different between two groups (p = 0.420, and p = 0.418, respectively). 5-year survival rates for T4 subcategories (invasion of other structures, ipsilateral different lobe pulmonary nodule, and tumor diameter > 7 cm) were 39.4%, 41.9%, and 50.3%, respectively (p = 0.109). Multivariate analysis showed that age (p < 0.0001), nodal status (p = 0.0003), and complete resection (p < 0.0001) were independently influenced survival.

Conclusion

There is no significant difference in the prognosis between mediastinal fat tissue invasion and T4 disease in NSCLC patients.

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References

  1. Goldstraw P (2009) IASLC staging manual in thoracic oncology. In: International association for the study of lung cancer, 1st edn. Editorial Rx Press, Orange Park

  2. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136(1):260–71.

    Article  PubMed  Google Scholar 

  3. Detterbeck FC, Postmus PE, Tanoue LT. The stage classifi cation of lung cancer diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2013;143(5 Suppl):e191S–e210S.

    Article  PubMed  Google Scholar 

  4. Purandare NC, Rangarajan V. Imaging of lung cancer: implications on staging and management. Indian J Radiol Imaging. 2015;25(2):109–20.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Takahashi Y, Miyajima M, Mishina T, et al. Thoracoscopic one-stage lobectomy and diaphragmatic plication for T3 lung cancer. J Cardiothorac Surg. 2018;13(1):86.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Goldstraw P, Crowley JJ, Chansky K, et al. The IASLC lung cancer staging project: proposals for revision of the stage groupings in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:706–14.

    Article  PubMed  Google Scholar 

  7. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39–51.

    Article  PubMed  Google Scholar 

  8. Metin M, Citak N, Sayar A, et al. The role of extended cervical mediastinoscopy in staging of non-small cell lung cancer of the left lung and a comparison with integrated positron emission tomography and computed tomography: does integrated positron emission tomography and computed tomography reduce the need for invasive procedures? J Thorac Oncol. 2011;6(10):1713–9.

    Article  PubMed  Google Scholar 

  9. Yamamoto K, Miyamoto Y, Ohsumi A, Imanishi N, Kojima F. Surgical results of carinal reconstruction: an alternative technique for tumors involving the tracheal carina. Ann Thorac Surg. 2007;84:216–20.

    Article  PubMed  Google Scholar 

  10. Sayar A, Solak O, Metin M, et al. Carinal resection and reconstruction for respiratory tumors using Miyamoto’s technique. Gen Thorac Cardiovasc Surg. 2012;60:90–6.

    Article  PubMed  Google Scholar 

  11. Kreisman H, Lisbona A, Olson L, et al. Effect of radiologic stage III substage on nonsurgical therapy of non-small cell lung cancer. Cancer. 1993;72(5):1588–96.

    Article  CAS  PubMed  Google Scholar 

  12. Quint LE. Lung cancer: assessing resectability. Cancer Imaging. 2003;4(1):15–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Quint LE. Staging non-small cell lung cancer. Cancer Imaging. 2007;7(1):148–59.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Watanabe S, Asamura H, Miyaoka E, et al. Results of T4 surgical cases in the Japanese lung cancer registry study: should mediastinal fat tissue invasion really be included in the T4 category? J Thorac Oncol. 2013;8:759–65.

    Article  PubMed  Google Scholar 

  15. Uramoto H, Tanaka F. Recurrence after surgery in patients with NSCLC. Transl Lung Cancer Res. 2014;3(4):242–9.

    PubMed  PubMed Central  Google Scholar 

  16. Lacasse Y, Bucher HC, Wong E, et al. “Incomplete Resection” in non-small cell lung cancer: need for a new definition. Canadian Lung Oncology Group. Ann Thorac Surg. 1998;65(1):220–6.

    Article  CAS  PubMed  Google Scholar 

  17. Rami-Porta R, editor. Staging handbook in thoracic oncology. 2nd ed. Orange Park: Editorial Rx Press; 2016.

    Google Scholar 

  18. Butnor KJ, Travis WD. Recent advances in our understanding of lung cancer visceral pleural invasion and other forms of minimal invasion: implications for the next TNM classification. Eur J Cardiothorac Surg. 2013;43(2):309–11.

    Article  PubMed  Google Scholar 

  19. Otsuka H, Ishii G, Yoshida J, et al. Tumor invasion of extralobar soft tissue beyond the hilar region does not affect the prognosis of surgically resected lung cancer patients. J Thorac Oncol. 2010;5(10):1571–5.

    Article  PubMed  Google Scholar 

  20. Sakai Y, Ohbayashi C, Kanomata N, et al. Significance of microscopic invasion into hilar peribronchovascular soft tissue in resection specimens of primary non-small cell lung cancer. Lung Cancer. 2011;73(1):89–95.

    Article  PubMed  Google Scholar 

  21. Briedienė R, Mamontovas V. Radiological diagnostics of pleura and mediastinum invasion in lung cancer patients. Acta Medica Lituanica. 2005;12:68–72.

    Google Scholar 

  22. Citak N, Büyükkale S, Sayar A, et al. Prognostic factors and survival in patients undergoing surgery for T4 nonsmall cell lung carcinoma. Acta Chir Belg. 2014;114(1):17–24.

    Article  CAS  PubMed  Google Scholar 

  23. Farjah F, Wood DE, Varghese TK, et al. Trends in the operative management and outcomes of T4 lung cancer. Ann Thorac Surg. 2008;86:368–74.

    Article  PubMed  Google Scholar 

  24. Yamanashi K, Menju T, Hamaji M, et al. Prognostic factors related to postoperative survival in the newly classified clinical T4 lung cancer. Eur J Cardiothorac Surg. 2020;57(4):754–61.

    PubMed  Google Scholar 

  25. Li Q, Zhang P, Wang Y, et al. T4 extension alone is more predictive of better survival than a tumour size > 7 cm for resected T4N0-1M0 non-small-cell lung cancer. Eur J Cardiothorac Surg. 2019;55(4):682–90.

    Article  PubMed  Google Scholar 

  26. Song YT, Yang SL, Fu Z, et al. Prognostic value of adjuvant therapy in T4 non-small cell lung cancer: An inverse probability of treatment weighting analysis. Thorac Cancer. 2019;10(3):472–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Tevfik Saglam Cd No 1 Dr. Sadi Konuk Hastanesi, Bakirköy, 34010, Istanbul, Turkey

    Necati Çitak, Özgür İşgörücü & Barış Açıkmeşe

  2. Yedikule Thoracic Surgery and Chest Disease Hospital, Istanbul, Turkey

    Yunus Aksoy, Ciğdem Obuz, Neslihan Akalın Fener & Muzaffer Metin

  3. Private Memorial Hospital Istanbul, Istanbul, Turkey

    Songül Büyükkale & Adnan Sayar

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  1. Necati Çitak
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  2. Yunus Aksoy
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  3. Özgür İşgörücü
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  6. Songül Büyükkale
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  8. Muzaffer Metin
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Correspondence to Necati Çitak.

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Çitak, N., Aksoy, Y., İşgörücü, Ö. et al. The prognostic impact of the mediastinal fat tissue invasion in patients with non-small cell lung cancer. Gen Thorac Cardiovasc Surg 69, 76–83 (2021). https://doi.org/10.1007/s11748-020-01440-0

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  • DOI: https://doi.org/10.1007/s11748-020-01440-0

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