Investigating the predictive factors of thoracic aortic invasion and surgical outcomes in patients with primary lung cancer: A retrospective study

• Published in: Thoracic cancer Vol. 15; no. 15; pp. 1263 - 1270
• Main Authors: Ichinokawa, Hideomi, Takamochi, Kazuya, Fukui, Mariko, Hattori, Aritoshi, Matsunaga, Takeshi, Suzuki, Kenji
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.05.2024; John Wiley & Sons, Inc; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - pathology; Aorta, Thoracic - surgery; Approximation; Cancer therapies; computed tomography; Contact angle; Coronary vessels; extended surgery; Female; Humans; Localization; Lung cancer; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical prognosis; Middle Aged; Multivariate analysis; Neoplasm Invasiveness; Original; Prognosis; Retrospective Studies; Squamous cell carcinoma; Surgery; Surgical outcomes; thoracic aortic invasion; Tomography; Treatment Outcome; Tumors; T4; computed tomography; lung cancer; extended surgery; thoracic aortic invasion
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.15311

Background This study aimed to investigate predictors of thoracic aortic invasion in lung cancer patients using preoperative clinical and imaging characteristics and elucidate surgical outcomes in cases of aortic invasion. Methods Of the 4751 lung cancer patients who underwent surgery at our hospital, we included 126 (6.8%) who underwent left‐sided surgery and in whom tumor appeared to be in contact with the thoracic aorta on preoperative imaging. The patients were divided into two groups: group A, 23 patients (18%) who underwent combined aortic resection (+); group B, 103 patients (82%) who did not undergo combined aortic resection (−). Results The percentage of aortic invasion for tumor diameter <3 cm, 3–4 cm, 4–5 cm, 5–7 cm, and >7 cm was 0%, 13%, 23%, 16%, and 35%, respectively. The percentages of aortic invasion were 27%, 16%, and 0% for tumor localization in the upper division, S6, and S10, respectively. Multivariate analysis revealed that aortic depression due to tumor or loss of fatty tissue between tumor and mediastinum in the chest CT significantly predicted aortic invasion (odds ratio = 23.83, 16.66). Group A demonstrated significantly more blood loss, longer operative time, prolonged hospital stay, and increased percentage of recurrent nerve palsy (13%) compared to group B. The 1‐, 3‐, and 5‐year survival rates for patients in group A were 53.4%, 24.3%, and 24.3%, respectively. Conclusion If the chest CT of a patient demonstrates aortic depression due to tumor or loss of fatty tissue between tumor and mediastinum, aortic complications should be considered when planning surgery. The percentage of aortic invasion for tumor diameter <3 cm, 3–4 cm, 4–5 cm, 5–7 cm, and >7 cm was 0%, 13%, 23%, 16%, and 35%, respectively. The percentages of aortic invasion were 27%, 16%, and 0% for tumor localization in the upper division, S6, and S10, respectively. Multivariate analysis revealed that aortic depression due to tumor or loss of fatty tissue between tumor and mediastinum in the chest CT significantly predicted aortic invasion (odds ratio = 23.83, 16.66).