对于非小细胞肺癌患者，根治性肺手术需要达到阴性边缘。过去几十年来，该边缘的残余病变已被彻底研究。然而，在肺叶切除术后，气管膜外层侵犯对预后的影响尚不清楚。本研究旨在调查肺叶切除术后气管膜外层侵犯的临床影响。我们回顾性收集了2012年至2018年间在上海胸科医院连续接受肺叶切除术（包括套袖式肺叶切除术）的591例患者的临床数据。根据气管膜外层侵犯的情况，将患者分为两组（有气管膜外层侵犯组和无气管膜外层侵犯组）。评估无病生存和总体生存，并讨论肺叶切除术后有气管膜外层侵犯的患者是否需要放射治疗。在倾向评分匹配以平衡基线特征后，气管膜外层侵犯组和无气管膜外层侵犯组各有167名个体。在风险分析中，我们发现气管膜外层侵犯增加了复发风险（风险比：0.652; P = 0.002），并降低了长期生存率（P < 0.001）。亚组分析显示，尤其是在纵隔淋巴结阳性时，气管膜外层侵犯是一个重要的危险因素。此外，气管膜外层侵犯促进了胸外淋巴结转移。我们发现放射治疗不能改善气管膜外层侵犯组患者的预后。肺叶切除术后，气管膜外层侵犯是非小细胞肺癌的危险因素，并且可能增加胸外淋巴结转移的风险。此外，气管膜外层侵犯对术后放射治疗不敏感。版权所有 © 2023作者。由Elsevier Inc.发表并保留所有权利。

For patients with non-small cell lung cancer, a negative margin status is required for radical pulmonary surgery. Residual disease of the margin has been thoroughly studied in the past few decades. However, the prognostic significance of tracheal tunica adventitia invasion after lobectomy remains unclear. In this study, we aimed to investigate the clinical influence of tracheal tunica adventitia invasion after lobectomy.We retrospectively collected the clinical data of 591 patients who consecutively underwent pulmonary lobectomy, including sleeve lobectomy, between 2012 and 2018 at Shanghai Chest Hospital. According to the tracheal tunica adventitia invasion status, we allocated the patients into 2 groups (tracheal tunica adventitia invasion and non-tracheal tunica adventitia). Disease-free and overall survival were evaluated, and we discussed the necessity of radiotherapy in patients with tracheal tunica adventitia.After propensity score matching to balance baseline characteristics, there were 167 individuals in the tracheal tunica adventitia invasion and non-tracheal tunica adventitia groups. In the hazard analysis, we found that tracheal tunica adventitia increased the risk of recurrence (hazard ratio: 0.652; P = .002) and impaired long-term survival (P < .001). Subgroup analysis revealed that tracheal tunica adventitia was an important risk factor, especially when the hilar lymph nodes were positive. In addition, tracheal tunica adventitia invasion promoted extra-thoracic lymph node metastasis. We discovered that radiotherapy did not improve the prognosis of patients in the tracheal tunica adventitia invasion group.After lobectomy, tracheal tunica adventitia invasion is a risk factor for non-small cell lung cancer and potentially increases extra-thoracic lymph node metastasis. Moreover, tracheal tunica adventitia invasion is not sensitive to postoperative radiotherapy.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.