外科治疗同时性多原发肺癌的临床分析

Clinical analysis of surgical treatment of synchronous multiple primary lung cancers

目的分析和总结同时性多原发肺癌的临床病理学特点及外科治疗的预后情况,指导临床实践。方法对72例接受外科手术的同时性多原发肺癌患者的临床资料进行回顾性分析,记录所有患者手术方式,分析第一原发癌患者术后病理结果、总体生存曲线以及影响因素。结果第一原发癌采用肺叶切除29例、肺段切除15例、肺楔形切除28例,第二原发癌采用肺叶切除20例、肺段切除4例、肺楔形切除48例,第三原发癌采用肺叶切除2例、肺段切除2例、肺楔形切除7例,其他原发癌采用肺叶切除1例、肺段切除1例、肺楔形切除3例。患者手术方式第一原发癌为腺癌的65例(90.3%),第二原发癌同样以腺癌为主,共68例(94.4%),其中第一原发癌为腺癌合并第二原发癌为腺癌共63例(87.5%),其第二原发癌的亚型包括:浸润性腺癌25例,微浸润性腺癌22例,原位腺癌16例。第一原发癌病理T1期48例、T2期24例,淋巴结N0期62例、N1期4例、N2期6例。生存分析显示,3、5年生存率分别为91.7%、72.2%。单因素分析显示,第一原发癌直径、T分期、N分期均为远期生存率的影响因素(P<0.05)。结论同时性多原发肺癌的诊断应该结合临床表现、影像学特征、病理诊断等多方面进行;其预后与第一原发癌的直径和分期有显著关系。

Objective To analyze and summarize the clinicopathological characteristics and prognosis of surgical treatment of synchronous multiple primary lung cancers,and guide clinical practice.Methods The clinical data of 72 patients with synchronous multiple primary lung cancers who underwent surgical treatment were retrospectively analyzed,the surgical methods of all patients were recorded,and the postoperative pathological results,overall survival curve and influencing factors of the first primary cancer patients were analyzed.Results The first primary cancer was treated by lobectomy in 29 cases,segmental resection in 15 cases,and wedge resection in 28 cases.The second primary cancer was lobectomy in 20 cases,segmental resection in 4 cases,and wedge resection in 48 cases.The third primary cancer was treated by lobectomy in 2 cases,segment resection in 2 cases,and wedge resection in 7 cases.Other primary cancers was treated by lobectomy in 1 case,segmental resection in 1 case,and wedge resection in 3 cases.The first primary cancer of 65 cases(90.3%)was adenocarcinoma,and the second primary cancer was also mainly adenocarcinoma,a total of 68 cases(94.4%).Among them,63 patients(87.5%)had the first primary cancer as adenocarcinoma and the second primary cancer as adenocarcinoma,and its second primary cancer subtypes include:25 cases of invasive adenocarcinoma,22 cases of microinvasive adenocarcinoma,and 16 cases of adenocarcinoma in situ.First primary cancer pathological stage:48 cases in T1 stage and 24 cases in T2 stage.Lymph node stage:60 cases in N0 stage,4 cases were N1 stage,and 6 cases in N2 stage.Survival analysis showed that the 3-and 5-year survival rates were 91.7%and 72.2%,respectively.Single factor analysis showed that the diameter,T stage and N stage of the first primary cancer were all the factors influencing the long-term survival rate of the patients(P<0.05).Conclusion The diagnosis of synchronous multiple primary lung cancers should be combined with clinical manifestations,imaging features,and pathological diagnosis.Its prognosis is significantly related to the diameter and stage of the first primary cancer.