RESUMEN
A 69-year-old man was diagnosed with an abnormal shadow on a chest X-ray during a routine check-up. Computed tomography (CT) showed a 36 mm solid nodule at left S1+2, and 3 dimentional (3D)-CT showed the left B1+2 branching from the left main bronchus. Bronchoscopy showed branching of B1+2, B3~5, and inferior lobar bronchus from the left main bronchus, and a biopsy from the peripheral area of B1+2 confirmed the diagnosis of lung adenocarcinoma. Subsequently, video-assisted thoracoscopic surgery was performed for the lung adenocarcinoma (cT2aN0M0, â B). The dorsal pleura was incised and B1+2, which branches from the left main bronchus dorsal to the pulmonary artery, was identified. After dissecting B1+2, the fissure between the upper division and lower lobes was separated, followed by left upper lobectomy with ND2a-1. The preoperative understanding of the anatomical abnormalities obtained using 3D-CT allowed the surgery to be performed safely.
Asunto(s)
Bronquios , Neoplasias Pulmonares , Neumonectomía , Humanos , Masculino , Anciano , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/diagnóstico por imagen , Bronquios/cirugía , Bronquios/anomalías , Bronquios/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adenocarcinoma/cirugía , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma del Pulmón/cirugía , Adenocarcinoma del Pulmón/diagnóstico por imagenRESUMEN
OBJECTIVES: Body composition and systemic inflammation/nutrition have been identified as important clinical factors in cancer patients. The modified advanced lung cancer inflammation index (mALI), which combines body composition and systemic inflammation/nutrition, is defined as appendicular skeletal muscle index × serum albumin/neutrophil-lymphocyte ratio. This retrospective study aimed to investigate associations between preoperative mALI and surgical outcomes in non-small cell lung cancer (NSCLC) patients. METHODS: We examined 665 patients with resectable stage I-III NSCLC who underwent pulmonary resection. Patients were divided into low-mALI (n = 168) and high-mALI (n = 497) based on the lower quartile. Kaplan-Meier curves and Cox regression analysis were used to assess the prognostic value of mALI. We then performed 1:1 propensity score matching (PSM) for high- and low-mALI to further investigate impacts on survival. RESULTS: Overall survival (OS) and recurrence-free survival (RFS) were both significantly poorer in the low-mALI group than in the high-mALI group (58.2% vs. 79.6%, P < 0.001; 48.8% vs. 66.7%, P < 0.001, respectively). Multivariate analysis revealed low-mALI as an independent predictor of OS (hazard ratio [HR], 2.116; 95% confidence interval (CI) 1.458-3.070; P < 0.001) and RFS (HR, 1.634; 95% CI 1.210-2.207; P = 0.001). After PSM, low-mALI remained as an independent predictor of OS (HR, 2.446; 95% CI 1.263-4.738; P = 0.008) and RFS (HR 1.835; 95% CI 1.074-3.137; P = 0.026). CONCLUSION: Preoperative mALI appears to offer an independent predictor of poor surgical outcomes as a simple, routinely available, and inexpensive biomarker in patients with resectable NSCLC.