title: Lung cancer invading the pericardium: quantum of lymph nodes.
abstract: BACKGROUND
  Lung cancer may invade the pericardium (T3) and the intrapericardial pulmonary veins and left atrium (T4). Our purpose was to analyze the characteristics of this invading process in search of the reasons explaining its poor prognosis.
  
  
  METHODS
  The clinical records of 4,668 patients who underwent surgery for lung cancer between January 1983 and December 2006 in two thoracic surgery centers were retrospectively reviewed. The epidemiology, pathology, and prognostic characteristics of the tumors invading the pericardium alone (T3) or with pulmonary veins and atrium (T4) were analyzed and compared with all other tumors.
  
  
  RESULTS
  There were 75 male and 16 female patients, with 85 pneumonectomies and 6 lobectomies that proved R0 in 59.3% of patients, and contained 69 squamous cell cancers, 11 adenocarcinomas, and 13 miscellaneous tumors; 12 were N0 (13.2%), 31 were N1 (34.1%), and 48 were N2 (52.8%). Pericardium alone was invaded in 32 patients (35.2%), and with pulmonary vein and atrium in 34 (37.3%) and 25 (27.5%), respectively. Patient characteristics were similar in each group. Five-year and 10-year survival rates were 15.1% and 10.4%, respectively. Frequency of pneumonectomy, R1-2 resection, and N1-2 involvement were significantly more important compared with noninvading tumors (p < 10(-6)).
  
  
  CONCLUSIONS
  Reports on T3 and T4 cancer with pericardial involvement are few, but also stress that pulmonary vein and left atrium invasion does not worsen the prognosis more than pericardial invasion alone. The rich pericardial lymph drainage might enhance the spread of tumor cells, explaining excessively high N1-N2 rates and pericardial invasion-related poor prognosis.
authors.affiliation: General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France. marc.riquet@egp.aphp.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.forename: Bertrand
authors.initials: B
authors.lastname: Grand
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.forename: Ciprian F
authors.initials: CF
authors.lastname: Pricopi
authors.forename: Christophe
authors.initials: C
authors.lastname: Foucault
authors.forename: Antoine
authors.initials: A
authors.lastname: Dujon
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
mesh_terms: D001999:Bronchoscopy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006325:Heart Atria; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010496:Pericardium; D011013:Pneumonectomy; D011379:Prognosis; D011667:Pulmonary Veins; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology*