Prognostic impact of pathologically confirmed rib invasion in patients with lung cancer requiring chest wall resection

Abstract

Background: Primary lung cancer that invades the chest wall is classified as T3 regardless of the depth of invasion. This study assessed the prognostic impact of pathologically confirmed rib invasion in patients with pT3N0-1 lung cancer requiring chest wall resection. Methods:We retrospectively analyzed the records of patients with non-small cell lung cancer (NSCLC) who underwent combined lung and chest wall resection with rib involvement from 2006 to 2019. The median follow-up period was 64.0 months. Results:In total, 42 patients (41 men, 1 woman) were enrolled. The median patient age was 64 years (range, 42-79 years). The median tumor size before treatment was 56.5 mm (range, 21-80 mm), and an osteolytic sign was identified on computed tomography (CT) in 42.9% (18/42). Among 27 patients who received induction chemoradiotherapy, 5 (18.5%) achieved a complete pathological response. The operations comprised 36 lobectomies, 5 segmentectomies, and 1 wedge resection with resection of 2.5 ribs on average.Pathological examination revealed rib invasion in 18 (42.9%) patients. The 5-year disease-free and overall survival rates with pathological rib invasion were 44.4% and 77.4% (P=0.0114), respectively and those without pathological rib invasion were 44.7% and 81.3% (P=0.0222), respectively. Pathologically confirmed rib invasion was the only factor identified to have a prognostic impact in the univariate and multivariate analyses (hazard ratio, 5.98; 95% confidence interval: 1.37-26.1). Locoregional recurrence and distant metastases were more common in patients with than without pathologically confirmed rib invasion [4 (22.2%) and 6 (33.3%), respectively, among 18 patients with pathological rib invasion; 2 (8.3%) and 3 (12.5%), respectively, among 24 patients without pathological rib invasion] (P=0.0073).Conclusions: Pathologically confirmed rib invasion was found to have a significant unfavorable prognostic impact in patients with pT3N0-1 lung cancer requiring chest wall resection. Multimodal therapy may be preferable in these patients to prevent local and distant relapse.

Extended radical resection and chest wall reconstruction for a pulmonary sarcomatoid carcinoma: a case report

“…Imaging studies in this patient revealed a right upper lobe mass invading the chest wall, preoperative pathological puncture revealed poorly differentiated NSCLC, and postoperative pathology confirmed PSC. In tumor, node, and metastasis staging, primary lung cancer infiltrating the chest wall is classified as stage T3, regardless of the depth of invasion [ 6 ]. Lobectomy and complete resection of the chest wall can be performed for a radical cure in this type of NSCLC, provided no lymph node metastasis exists [ 8 ].…”

“…The 3rd, 4th, and 5th ribs and the chest wall were removed to ensure that the incisal margin was at least 2 cm away from the tumor (Fig. 2 ) [ 6 ]. Next, we resected the right upper lobe and systematically dissected the lymph nodes.…”

“…Even in patients with PSC invading the chest wall, complete resection of the primary tumor and the affected chest wall is reportedly beneficial for long-term survival without evidence of lymph node metastasis [ 4 ]. However, chest wall resection destroys the stability and airtightness of the thoracic cavity, and resection of a large area of the bony chest wall may even cause chest wall softening, paradoxical breathing, and scoliosis [ 5 , 6 ]. Therefore, effective chest wall reconstruction is particularly important to reduce surgical complications and improve the quality of life of patients [ 7 ].…”

Breaking through the chest wall: the prognostic significance of rib invasion in lung cancer surgery

“…The American Joint Commission on Cancer 8 th edition classifies all tumors with chest wall invasion as T3, regardless of whether the tumor involves the parietal pleura only, the intercostal muscles, or the ribs, yet the degree of chest wall invasion could have important therapeutic and prognostic implications ( 1 ). In this issue of the Journal of Thoracic Disease , Yutaka et al provide valuable insight into the prognostic impact of rib invasion in NSCLC patients undergoing chest wall resection ( 2 ).…”