侵襲臓器, N因子別にみた T3N0-2M0 非小細胞肺癌の手術成績の検討

金沢大学医薬保健研究域医学系The purpose of this study was to evaluate the results of surgical treatment of T3N0-2M0 non-small cell lung cancer according to involved organ and nodal status. Between 1973 and July 1997, 157 patients with T3 non-small cell lung cancer were surgically treated in our department. Five-year survival was 23% for all cases, 35% for patients with curative resection, and 0% for patients with non-curative resection (p < 0.001). Five-year survival rate of patients with T3N0, T3N1, and T3N2 was 37%, 39%, and 3%, respectively (T3N0 vs T3N2, T3N1 vs T3N2, p < 0.01). According to the depth of chest wall involvement of T3N0 tumor, 5-year survival rate was 50% in the patients with the involvement of parietal pleura, 39% in the patients with the involvement of intercostal muscle, and 15% in the patients with the involvement of rib or more (parietal pleura vs rib or more, p < 0.05). In T3N0 patients with the involvement of only parietal pleura, the 5-year survival rate of parietal pleurectomy and en bloc chest wall resection was 43% and 46%, respectively (N.S.). Five-year survival rate of T3N1 patients with invasion in main stem bronchus was 46% and 3 of 5 patients of T3N0-1 tumor with pericardial invasion survived more than 5 years. From these results, T3N0 tumor involving chest wall without rib invasion, and T3N0-1 tumor involving main bronchus and pericardium are expected good survival. However, the prognosis of the patients with coexistent N2 disease or with incomplete resection remains poor in regardless with the type of involved organ. To correctly evaluate the surgical results of other types of T3 tumor, it is required to collect more cases or to perform multicenteric study