经手术治疗的多原发肺癌21例疗效分析

Study on 21 cases of multiple primary lung cancer

目的 探讨多原发肺癌（MPLC）的临床特点,为MPLC的正确诊断和治疗提供并积累信息.方法 收集2009年3月至2012年9月期间中国医学科学院肿瘤医院胸外科收治患者的临床资料进行归纳分析.结果 基于术前影像学检查提示MPLC,21例患者均首先接受了外科治疗,手术切除肺内肿瘤病灶共49个.术后被组织病理学检查证实本组21例均为MPLC,均为非小细胞肺癌;其中,肿瘤位于同侧肺者11例,位于双侧肺者10例;肿瘤同时性发生者17例,异时性发生者4例;两灶者14例,三灶者6例,四灶者1例;多发病灶之间组织学类型不同者2例（腺癌与鳞癌、鳞癌与原位癌,各1例）,多发病灶之间组织学类型相同者19例（17例腺癌,2例鳞癌）.患者中Ⅰ期14例、Ⅱ期2例、Ⅲ期5例.结论 对于影像学检查提示高度怀疑MPLC者,只要患者身体条件允许,建议积极手术切除以求获得最佳疗效;有待建立辅助术前诊断MPLC的影像学标准,研发辅助组织病理学诊断或鉴别MPLC的分子标志.

Objective To explore the clinical characteristics of multiple primary lung cancer （MPLC） and provide potential clues to the early diagnosis and treatment selection of MPLC patients. Methods The clinical data of 21 patients with MPLC confirmed by postoperative histopathology were analyzed retrospectively. Results All the 21 patients received surgery （pulmonary lobectomy or pulmonary wedge resection ）, and 49 intrapulmonary tumors were resected. The histopathologieal examination demonstrated that all the 21 cases were MPLC. Among the 21 patients, l0 had bilateral lesions in lung and 11 had unilateral lesions; 17 suffered synchronous and 4 suffered metachronous tumors; 14 had double two primary tumors, 6 had three primary tumors and 1 had four primary tumors. In these patients, 2 had various histological subtypes among their multiple lesions and 19 had same histological subtypes among their multiple tumors; 14 cases with stage I disease, stage H 2 cases, stage m 5 cases. Conclusions For the patients who were detected as MPLC by diagnostic imaging examination, more positive therapeutic decision, such as surgery, could be suggested. The molecular markers should be developed for assisting diagnosis of MPLC.