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山东大学学报(医学版) ›› 2017, Vol. 55 ›› Issue (11): 42-46.doi: 10.6040/j.issn.1671-7554.0.2017.141

• 临床医学 • 上一篇    下一篇

61例肺部多发病灶患者的外科治疗

彭岳,冯振,谢厚耐,王晖,李猛,任万刚,刘通,彭忠民   

  1. 山东大学附属省立医院胸外科, 山东 济南 250021
  • 收稿日期:2017-02-14 出版日期:2017-11-10 发布日期:2017-11-10
  • 通讯作者: 彭忠民. E-mail:pengzhm@163.com E-mail:pengzhm@163.com
  • 基金资助:
    山东省科技发展计划(2012GSF11826)

Surgical treatment for 61 patients with multiple lung lesions

PENG Yue, FENG Zhen, XIE Hounai, WANG Hui, LI Meng, REN Wangang, LIU Tong, PENG Zhongmin   

  1. Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China
  • Received:2017-02-14 Online:2017-11-10 Published:2017-11-10

摘要: 目的 分析肺部多发病灶患者的外科治疗效果,为临床诊疗提供依据。 方法 选择2012年5月至2016年4月我院胸外科61例临床资料保存完整且术前临床诊断为同时性多原发非小细胞肺癌(SMPLC)的病例,对这些患者的临床病理学特征、外科治疗及术后生存情况进行回顾性分析。 结果 61例肺部多发病灶患者中,47例存在2处或以上恶性病灶,10例存在1处恶性病灶,4例病灶全为良性。41例患者确诊为SMPLC,1年和3年总生存率分别为97.0%和77.5%。肿瘤最大直径越小(χ2=10.918, P=0.012)、病灶实性成分越少2=10.754, P=0.005)、无淋巴结转移2=10.234, P=0.001)以及TNM分期越早(χ2=12.068, P=0.007)的SMPLC患者预后越好。 结论 对于肺部多发病灶患者,若考虑SMPLC可能性大且胸部CT无纵隔淋巴结转移,建议首选手术治疗。

关键词: 肺部多发病灶, 多原发肺癌, 同时性多原发非小细胞肺癌, 外科治疗

Abstract: Objective To provide experiences for clinical diagnosis and treatment by analyzing the surgical outcomes for patients with multiple lung lesions. Methods Clinical data of 61 patients with clinical diagnosis of synchronous multiple primary non-small cell lung cancer(SMPLC)were collected from May 2012 to Apr. 2016 in our hospital. The clinicopathologic features, surgical treatment and overall survival(OS)were retrospectively analyzed. Results Among the 61 patients, 47 patients were verified with more than one malignant tumors. Ten patients were verified with only one malignant tumor, and all lesions of the other 4 patients were benign. Forty-one patients were finally diagnosed with SMPLC after surgical treatment. The 1-year and 3-year OS rates were 97.0% and 77.5%, respectively. Smaller dimension of maximal tumor(χ2=10.918, P=0.012), lesions with less solid ingredient(χ2=10.754, P=0.005), lymph nodes metastases negative(χ2=10.234, P=0.001)and earlier TNM stage(χ2=12.068, P=0.007)were correlated with better OS. Conclusion For patients with multiple lung lesions, if the diagnosis of SMPLC can not be excluded and there is no lymph nodes metastases in thoracic computed tomography, surgical treatment can be considered preferentially.

Key words: Multiple lung lesions, Synchronous primary lung cancer, Surgical treatment, Multiple primary non-small cell lung cancer

中图分类号: 

  • R734.2
[1] Arai J, Tsuchiya T, Oikawa M, et al. Clinical and molecular analysis of synchronous double lung cancers[J]. Lung Cancer, 2012, 77(2): 281-287.
[2] Martini N, Melamed MR. Multiple primary lung cancers[J]. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
[3] Kozower BD, Larner JM, Detterbeck FC, et al. Special treatment issues in non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2013, 143(5 suppl): e369S-e399S.
[4] Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming(seventh)edition of the TNM classification of malignant tumors[J]. J Thorac Oncol, 2007, 2(8): 706-714.
[5] National Comprehensive Cancer Network.(NCCN)Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer, Version 2. 2017[EB/OL].[2016-10-26] [2017-01-12] https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
[6] Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for revision of the TNM stage groupings in the forthcoming(eighth)edition of the TNM classification for lung cancer[J]. J Thorac Oncol, 2016, 11(1): 39-51.
[7] Park CM, Goo JM, Lee HJ, et al. Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up[J]. Radiographics, 2007, 27(2): 391-408.
[8] Fan L, Liu SY, Li QC, et al. Multidetector CT features of pulmonary focal ground-glass opacity: differences between benign and malignant[J]. Br J Radiol, 2012, 85(1015): 897-904.
[9] 周丽娜, 吴宁, 李蒙. 多层螺旋CT对同时多原发肺癌的诊断价值[J]. 癌症进展, 2012, 10(1): 64-68. ZHOU Lina, WU Ning, LI Meng. Diagnostic value of multi-slice spiral CT in synchronous multiple primary lung cancer[J]. Ai Zheng Jin Zhan, 2012, 10(1): 64-68.
[10] Shimizu K, Ikeda N, Tsuboi M, et al. Percutaneous CT-guided fine needle aspiration for lung cancer smaller than 2cm and revealed by ground-glass opacity at CT[J]. Lung Cancer, 2006, 51(2): 173-179.
[11] 高玉军, 李道堂. 肺多发磨玻璃结节处理策略的研究进展[J].中国肿瘤杂志, 2016, 25(7): 529-533. GAO Yujun, LI Daotang. Progress on processing strategy of multiple ground-grass opacity[J]. China Cancer, 2016, 25(7): 529-533.
[12] MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017[J]. Radiology, 2017, 284(1):228-243.
[13] Kim HK, Choi YS, Kim K, et al. Management of ground-glass opacity lesions detected in patients with otherwise operable non-small cell lung cancer[J]. J Thorac Oncol, 2009, 4(10): 1242-1246.
[14] 陈海泉. 多原发非小细胞肺癌的诊断与外科治疗进展[J]. 中华胸部外科电子杂志, 2014, 1(1): 3-7. CHEN Haiquan. Advance on diagnosis and surgical management of multiple primary non-small cell lung cancers[J]. Chin J Thorac Surg(Electronic Edition), 2014, 1(1): 3-7.
[15] Kim HY, Shim YM, Lee KS, et al. Persistent pulmonary nodular ground-glass opacity at thin-Section CT: histopathologic comparisons[J]. Radiology, 2007, 245(1): 267-275.
[16] Takamochi K, Oh S, Matsuoka J, et al. Clonality status of multifocal lung adenocarcinomas based on the mutation patterns of EGFR and K-ras[J]. Lung Cancer, 2012, 75(3): 313-320.
[17] Dai L, Yang HL, Yan WP, et al. The equivalent efficacy of multiple operations for multiple primary lung cancer and a single operation for single primary lung cancer[J]. J Thorac Dis, 2016, 8(5): 855-861.
[18] Ishikawa Y, Nakayama H, Ito H, et al. Surgical treatment for synchronous primary lung adenocarcinomas[J]. Ann Thorac Surg, 2014, 98(6): 1983-1988.
[19] Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients[J]. J Thorac Cardiovasc Surg, 2007, 134(3): 630-637.
[20] Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers[J]. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
[21] Jung EJ, Lee JH, Jeon K, et al. Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer[J]. Lung Cancer, 2011, 73(2): 237-242.
[22] Liu M, He W, Yang J, et al. Surgical treatment of synchronous multiple primary lung cancers: a retrospective analysis of 122 patients[J]. J Thorac Dis, 2016, 8(6): 1197-1204.
[23] Slaughter DP, Southwick HW, Smejkal W. “Field cancerization” in oral stratified squamous epithelium. Clinical implications of multicentric origin[J]. Cancer, 1953, 6(5): 963-968.
[24] Zhang Z, Gao S, Mao Y, et al. Surgical outcomes of synchronous multiple primary non-small cell lung cancers[J]. Sci Rep, 2016, 6. DOI: 10.1038/srep23252.
[25] 李营, 金波, 施建新,等. 41例可手术多原发肺癌临床分析[J]. 中国癌症杂志, 2014, 24(9): 700-706. LI Ying, JIN Bo, SHI Jianxin, et al. Clinical analysis of 41 cases with resected multiple primary lung cancers[J]. China Oncology, 2014, 24(9): 700-706.
[26] Trousse D, Barlesi F, Loundou A, et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management[J]. J Thorac Cardiovasc Surg, 2007, 133(5): 1193-1200.
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