老年多发非小细胞肺癌的鉴别诊断与外科治疗

Multi-focal non-small-cell lung cancer in the elderly patients: differential diagnosis and surgical treatment

目的探讨老年患者肺内多发非小细胞肺癌(MFLC)的诊断策略及有效的治疗方法。方法对≥65岁的老年MFLC患者的临床资料进行回顾性分析,采用前期研究得出的鉴别诊断策略,对这类病人进行多原发肺癌或肺癌肺内转移的诊断。生存分析采用Kaplan-Meier法,以无病生存期作为研究终点,采用Log-rank检验作生存期比较。结果 2008年1月至2013年6月,共52例老年MFLC患者(每位患者2个肿块,共52对肿瘤)纳入研究,占同期MFLC患者的20.4%。52例患者中,接受单肺叶切除11例,肺叶+楔形切除19例,双肺叶切除11例,肺段+楔形切除2例,楔形+楔形切除9例。无手术并发症或手术死亡病例。术后病理发现50对腺癌,2对腺癌-鳞癌组合。最终诊断为多原发肺癌32例,肺癌肺内转移20例,两类病人的2年无病生存率分别为72.7%和49.2%,差异有统计学意义(P=0.012)。结论老年MFLC患者逐年增加,应加强术前检查和鉴别诊断。对于最终诊断为多原发肺癌或者肺内转移的病人,治疗上应该区别对待,后者可能不能从手术治疗中获益。

Objective To investigate the diagnostic and therapeutic methods for muhi-focal non-small cell lung cancer （MFLC） in the elderly patients. Methods A prospectively recorded database of consecutive patients who underwent surgery for MFLC was reviewed. The elderly patients （/〉65 years） who had been followed up over 6 months were included in this study. The diagnostic strategy previously reported to differentiate muhi-primary lung cancers from intra-pulmo- nary metastasis was adopted. Survival curves were estimated by the Kaplan-Meier method and compared using the log-rank test. Results Fifty-two elderly patients with MFLC underwent surgery in our center from January 2008 to May 2013, ac- counting for 20.4% of all MFLC patients. Among these patients, 11 were treated by lobectomy, 19 by lobectomy plus wedge resection, 11 by bilobectomy, 2 by segmetectomy plus wedge resection, and 9 by two wedge resections. No mortality and morbidity occurred in perioperative time. Pathologic outcomes reported 50 cases of double adenocarcinomas and 2 cases of the combinations of adenocarcinoma and squamous cell carcinoma. Final diagnosis defined 32 cases as multi-primary lung cancer and 20 as intra-pulmonary metastasis. The 2-year relapsed-free survival was 72. 7% and 49. 2%, respectively （P= O. 012）. Conclusions Elderly patients with MFLC are increasing in frequency. Differential diagnosis of multiple primaries or intra-pulmonary metastasis is significant. Depending on the diagnosis, these patients should be managed accordingly, and curative-intent resection may be beneficial to the former but not to the latter.