多病灶肺癌的临床病理特征及预后因素分析

Study on Clinicopathological Features and Prognostic Factors of Multifocal Lung Cancer

目的 分析多病灶肺癌(multifocal lung cancer,MFLC)的临床病理特征并探究其预后因素.方法 回顾性分析2012年1月-2018年1月四川大学华西医院术后病理诊断为MFLC、且最大病灶直径≤4 cm、无淋巴结转移、无胸膜转移及远处转移的187例患者的临床病理资料.采用Kaplan-Meier方法及多因素Cox风险比例回归模型进行生存分析以评估影响MFLC预后的独立危险因素.结果 187例患者中同时性MFLC 173例,异时性14例.所有患者术后5年无病生存(disease-free survival,DFS)率为63.5%,5年总生存(overall survival,OS)率为89.1%.根据2013版美国胸科医师协会(ACCP)诊断指南诊断同时性多原发肺癌133例,肺内转移癌40例,两组患者的DFS差异无统计学意义(P=0.531).对于同时性MFLC病例,表皮生长因子受体(epidermal growth factor receptor,EGFR)突变状态(突变相同、突变不同、均野生型)对患者DFS无影响(P=0.388).两实性结节〔风险比(hazard ratio,HR)=7.4,95%置信区间:1.7~32.8,P=0.008〕以及异时性癌(HR=5.6,95%置信区间:2.0~15.3,P=0.001)是预后不良(肿瘤复发)的两个独立危险因素.结论 MFLC早期行手术治疗可获得理想的预后.病灶的影像学密度及病灶发生时序(同时或异时)对预后判断有重要意义.

Objective To analyze the clinicopathological characteristics and prognostic factors of multifocal lung cancer(MFLC) patients. Methods From January 2012 to January 2018, 187 MFLC patients whose largest lesion diameter was ≤4 cm and without lymphatic involvement or systemic metastases, were retrospectively reviewed. All the patients received surgical treatment. The Kaplan-Meier method was used for survival analysis, and a multivariable Cox proportional hazards regression model was used to assess the independent prognostic factors. Results Among 187 cases,173 were simultaneous MFLC(SMFLC) and 14 were metachronous MFLC(MMFLC). The 5-year disease-free survival(DFS) and overall survival(OS) rates of this group MFLC patients were 63.5% and 89.1%, respectively. In the SMFLC group, according to the American College of Chest Physicians(ACCP) guidelines(3 rd edition), 133 patients were defined as synchronous multiple primary lung cancer(SMPLC) while 40 patients had intrapulmonary metastases, there was no statistical difference in DFS between the two subgroups(P=0.531). EGFR mutation status(same mutations, different mutations, all wild-type) had no statistically significant effect on DFS of SMFLC(P=0.388). Univariate and multivariate regression analysis revealed that radiographic feature of solid nodules(hazard ratio(HR)=7.4, P=0.008) and MMFLC(HR=5.6, P=0.001) were independent risk factors for poor prognosis. Conclusion MFLC can achieve a favorable prognosis with early surgical treatment. Tumor density and metachronous lesions are two important prognostic predictors.