The clinical outcome of non-small cell lung cancer patients with adjacent lobe invasion: The optimal classification according to the status of the interlobar pleura at the invasion point

Yoichi Ohtaki, Tomoyuki Hishida, Junji Yoshida, Genichiro Ishii, Akikazu Kawase, Keiju Aokage, Mitsuyo Nishimura, Kanji Nagai

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OBJECTIVES: The aim of this study was to analyse the survival of non-small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI) with emphasis on the interlobar fissure status at the tumour invasion point. METHODS: We retrospectively evaluated 2097 consecutive patients with surgically resected NSCLC from July 1993 through April 2006. Of these, 90 (4.3%) patients had tumours with ALI. We divided ALIs into two types by histological examination using elastic stains: direct ALI beyond the incomplete fissure (ALI-D, n = 18) and ALI across the interlobar fissure (ALI-A, n = 72), and compared the clinicopathological features and survival. RESULTS: The patients with ALI demonstrated an intermediate survival between T2a and T2b tumours (5-year overall survival: T2a, 61.0%; ALI, 59.6%; T2b, 49.2%). There were distinct survival differences between the patients with ALI-A and ALI-D (5-year overall survival: ALI-D, 85.7%; ALI-A, 52.0%; P = 0.010). The survival of patients with ALI-A was not statistically different from that of patients with T2b tumours, regardless of the tumour size (P = 0.846). The survival of the patients with ALI-D did not statistically differ from those with T1a or T1b tumours (P = 0.765 and 0.418, respectively). CONCLUSIONS: Our results indicate that the interlobar fissure status affects the survival of the patients with ALI. ALI should be examined by elastic stains and only ALI-A should be classified as true ALI. We propose that ALI-A tumours with a size of ≤5 cm should be assigned to T2b, but ALI-D tumours do not require an adjustment of the T descriptor.

Original languageEnglish
Article numberezs268
Pages (from-to)302-309
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Issue number2
Publication statusPublished - 2013 Feb
Externally publishedYes



  • Adjacent lobe invasion
  • Interlobar fissure
  • Interlobar pleural invasion
  • Non-small cell lung cancer
  • Pleural invasion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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