title: [Place and role of the pleura in non-small cell lung cancer dissemination].
abstract: BACKGROUND
  The pleural involvement (PLI) in non-small cell lung cancer (NSCLC) has a poor prognosis, even though it might be very heterogeneous.
  
  
  METHODS
  A multicentric retrospective descriptive study was performed over 2329 patients who were operated for NSCLC between 1979 and 2010. The patients with PLI were classified in P(Parietal)PLI and V(visceral)PLI and then each subdivided : VPLI to peripheric (VPLI-P) and fissural (VPLI-F) and PPLI to mediastinal (PPLI-M) and costal (PPLI-C). Characteristics and survival were compared between the subgroups as well as with patients without PLI (WPLI, n=1439).
  
  
  RESULTS
  The sex-ratio was 2.8 (males: n=1713). The PLI patients were significantly younger, with a less sex-ratio, less R0 resections (96% versus 98.7%, P=0.000076), and less N0 (60% vs 70%, P<10(-6)) as their 5-year survival (45.7% vs 55.5%, P<10(-6)). The PLI was related to the size of NSCLC (P<10(-6)) and N2 involvement (P=0.0020). It was less frequent after neoadjuvant treatment (36.2% vs 39.1% P=0.03). In the VPLI-F or PPLI-M, pneumonectomies were more frequent (P<10(-6)). In VPLI-P (n=196/561), there were more pN1 and pN2 (P=0.0065) with a 5-year survival of 42.9% vs 54.4%, P=0.013. In multivariate analysis, the PLI was not an independent prognostic factor contrary to age, sex, type of resection, pT and pN.
  
  
  CONCLUSIONS
  The pleura play a major role in NSCLC dissemination. Its involvement affects pN, the type of surgical resection and justifies the use of neoadjuvant treatment.
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France. Electronic address: marc.riquet@egp.aphp.fr.
authors.forename: M
authors.initials: M
authors.lastname: Riquet
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France.
authors.forename: C
authors.initials: C
authors.lastname: Rivera
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France.
authors.forename: C
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France.
authors.forename: M
authors.initials: M
authors.lastname: Abdennadher
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France.
authors.forename: A
authors.initials: A
authors.lastname: Arame
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France.
authors.forename: C
authors.initials: C
authors.lastname: Foucault
authors.affiliation: Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois-Guillaume, France.
authors.forename: A
authors.initials: A
authors.lastname: Dujon
authors.affiliation: Service de chirurgie thoracique, université Paris-Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris France.
authors.forename: F
authors.initials: F
authors.lastname: Le Pimpec Barthes
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D047368:Tumor Burden
keywords: CBNPC; Chirurgie; Facteurs de survie; NSCLC; Pleura; Plèvre; Surgery; Survival