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Ann Thorac Surg 2004;78:1511-1512
© 2004 The Society of Thoracic Surgeons

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Correspondence

Adenosquamous Carcinoma of the Lung and Visceral Pleural Invasion

Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France

marc.riquet{at}hop.egp.ap-hop-paris.fr

To the Editor:

Nakagawa and colleagues [1] reported their findings on the poor prognosis for patients with adenosquamous carcinoma (ASC) of the lung after surgical resection. The authors concluded that patients with stage IA or IB ASC had a prognosis similar to that of patients with stage IIIA adenocarcinoma or squamous cell carcinoma. Nakagawa and co-authors also found significant differences in pathological pleural invasion characteristics between the two groups; the visceral and parietal was invaded (p2–p3) in 50% (15/30) of patients with ASC versus 26.8% (327/1,219) of those with adenocarcinoma or squamous cell carcinoma.

In 2001, one group [2] presented a study of 69 patients who underwent surgical resection for ASC of the lung. This study also confirmed the aggressive biological behavior of ASC. The other main characteristic of ASC was its propensity to invade the visceral pleura (p1–p2) (41%) and the parietal pleura (p3) (22%), a finding similar to that observed by Nakagawa and associates. Our study also demonstrated that peripheral location of ASC and visceral pleural invasion (VPI) were the only factors associated with a poor prognosis in the multivariate analysis. We postulated that such characteristics allow tumor cells to exfoliate within the pleural cavity and that the exfoliated tumor cells are absorbed by the parietal pleural lymphatics and reach the bloodstream, thus contributing to dissemination of cancer.

We [3] also observed that such a phenomenon was possible whatever the histology of the peripheral lung cancer but that VPI was twice more frequent in ASC. Furthermore, for the stage IIIA N2 subset, the survival rates of patients with one-station N2 involvement with VPI was close to that observed for patients with N2 involvement of two or more stations with or without VPI [3]. These survival results are comparable to those of Nakagawa and co-workers and suggest that reabsorption of parietal pleural lymphatic tumor cells behave as a metastatic mediastinal lymph node chain in the presence of VPI and that VPI can be likened to one-station N2 disease. This is the case whatever the lung cancer histology but appears particularly important in ASC because of the high frequency of VPI in this histological subgroup.

References

1. Nakagawa K, Yasumitu T, Fukuhara K, Shiono H, Kikui M. Poor prognosis after lung resection for patients with adenosquamous carcinoma of the lung. Ann Thorac Surg. 2003;75:1740–1744[Abstract/Free Full Text]
2. Riquet M, Perrotin C, Lang-Lazdunski L, et al. Do patients with adenosquamous carcinoma of the lung need a more aggressive approach? J Thorac Cardiovasc Surg. 2001;122:618–619[Free Full Text]
3. Manac'h D, Riquet M, Medioni J, Le Pimpec-Barthes F, Dujon A, Danel C. Visceral pleura invasion by non-small cell lung cancer: an underrated bad prognostic factor. Ann Thorac Surg. 2001;71:1088–1093[Abstract/Free Full Text]

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