S-324 Pleural recurrence after Transthoracic Lung Biopsy in Stage I Non-Small Cell Lung Cancer = S-324 Pleural recurrence after Transthoracic Lung Biopsy in Stage I Non-Small Cell Lung Cancer

다국어 초록 (Multilingual Abstract)

Background: Transthoracic needle biopsy (TTNB) is a useful modality for pathologic diagnosis of lung cancer. A risk of pleural dissemination after TTNB has been reported but remains a controversial issue. This study aimed to investigate whether the TTNB procedure increases the risk of pleural recurrence after curative resection and to identify the risk factors of pleural dissemination.?Methods: We retrospectively reviewed the clinical outcomes of p-stage I non-small cell lung cancer (NSCLC) patients who received curative lung resection for treatment between January 2009 and December 2010 at Samsung Medical Center. Patients who had double primary cancer and underwent limited resection due to poor lung function were excluded. Patients were divided into two groups, TTNB or non-TTNB, according to the procedure received before surgery. Kaplan-Meier analysis and log-rank test, and univariate and multivariate Cox regression analyses were used to determine the association between TTNB and pleural recurrence and identify the risk factors.?Results: Of the total 469 patients, 251 underwent TTNB before curative surgery, while the remaining 218 underwent bronchoscopic or open lung biopsy or had a clinical diagnosis. Of the 26 patients with ipsilateral pleural recurrence, 23 patients were in the TTNB group (23/251, 9.2%), whereas the remaining patient was in the non-TTNB group (3/218, 1.4%). Kaplan-Meier analysis showed that the TTNB group had lower pleural recurrence-free survival than the non-TTNB group(p＜0.001). Multivariate Cox analysis revealed, TTNB (adjusted hazard ratio[HR], 5.102; 95% CI, 1.502 to 17.327; p＝0.009), microscopic lymphatic invasion (adjusted HR, 2.765; 95% CI 1.226 to 6.232; p＝0.014), and microscopic visceral pleural invasion (adjusted HR, 2.693; 95% CI 1.177 to 6.164; p＝0.019) were risk factors for ipsilateral pleural recurrence.?Conclusions: The TTNB procedure was related to and increased the risk of ipsilateral pleural recurrence in stage I NSCLC after curative resection. Microscopic lymphatic invasion and visceral pleural invasion also increased the risk of ipsilateral pleural recurrence in this study.