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Ann Thorac Surg 2004;78:1512
© 2004 The Society of Thoracic Surgeons
Department of Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergy Diseases, 3-7-1, Habikino, Habikino City, Osaka, Japan, 583-8588
katuhiro{at}hbk.pref.osaka.jp
To the Editor:
Thank you for reading our report [1]. I agree that the prognosis for patients with adenosquamous carcinoma is poorer than that for patients with other histological types of lung cancer. I originally had assumed that pleural invasion was an independent prognostic factor, but this was not substantiated by the multivariate analysis. However, I think your opinion about pleural invasion is very useful and informative. I have encountered several patients with histopathological evidence of lymphatic invasion directly beneath the visceral pleura. The reason for the high frequency of pleural invasion associated with adenosquamous carcinoma compared with other histological types of lung cancer is unclear. Such subpleural lymphatic invasion may be an index of the aggressive behavior of adenosquamous carcinoma of the lung.
For patients with stage IIIA disease, which was treated by complete resection in our hospital between September 1976 and August 1998, the 5-year survival rate was 7.4% for patients who had involvement of only one mediastinal lymph node station (N2) with visceral pleural invasion (n = 71) and 27.2% for those who had involvement of one mediastinal lymph node station (N2) without visceral pleural invasion (n = 47). The 5-year survival rate was 16.1% for patients with involvement of two or more mediastinal lymph node stations (N2) irrespective of the status of visceral pleural invasion (n = 128). The outcome of patients who had involvement of only one lymph node station without visceral pleural invasion was significantly better than that of patients with other types of N2 disease.
As in the study of Riquet and coauthors [2], outcome did not differ significantly between patients who had involvement of one mediastinal lymph node station with pleural invasion and those who had involvement of two or more mediastinal lymph node stations irrespective of the status of visceral pleural invasion. In the patients with visceral pleural invasion, it can be imagined that tumor cells invading the parietal pleural lymph nodes were reabsorbed and transferred to the mediastinal lymph nodes; however, no direct evidence is available to corroborate this. It is an open question whether reabsorption of tumor cells in the parietal pleural can be verified clinically or experimentally.
The reasons for the poor prognosis for patients with adenosquamous carcinoma of the lung remain unclear. Perhaps techniques such as gene analysis will help to identify the most critical factors.
References
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