同时性双原发肺癌的临床和预后分析

Clinical and Prognostic Analysis of Synchronous Double Primary Lung Cancer

目的对同时性双原发肺癌(sDPLC)患者的临床资料进行分析,旨在进一步探讨sDPLC的临床特点、诊断、治疗手段及二代测序技术(NGS)的临床应用。方法搜集2015年1月1日至2019年12月31日郑州大学第一附属医院收治的89例sDPLC患者的所有临床资料,对临床特点、手术方式、肺癌驱动基因检测结果及患者生存情况进行分析。结果89例患者共178个病灶,病灶位于同侧肺叶多见(61/89,68.54%),总体以右肺上叶最常见(52/178,29.21%),病理类型以腺癌最常见(167/178,93.82%),病理类型相同者(78/89,87.64%)远多于不同者(11/89,12.36%)。手术方式以肺叶-楔形切除为主(45/89,50.56%)。38.76%(69/178)病灶接受肺癌驱动基因检测,突变率为86.96%(60/69),其中EGFR第21外显子L858R突变最常见(24/60,40.00%)。单因素生存分析显示吸烟史(P=0.033)、淋巴结转移(P<0.001)、病理类型不同(P=0.046)、最高TNM分期为Ⅱ~Ⅲ期(P<0.001)、胸膜侵犯(P=0.015)是sDPLC的不良预后因素。多因素生存分析显示病理类型相同患者较不同患者预后好(P=0.030),淋巴结无转移患者较有转移患者预后好(P=0.045),无胸膜侵犯患者较有侵犯患者预后好(P=0.048)。1、3、4 a的无病生存期(DFS)分别为94.50%、89.00%、66.70%,中位DFS为48.84个月。结论sDPLC好发于右肺上叶,以病理类型相同者多见,病理类型主要为腺癌。有淋巴结转移、有胸膜侵犯、分期相对较晚、有吸烟史、病理类型不同的患者预后相对较差,早期诊断、积极手术治疗和戒烟可使sDPLC患者获得较好预后。

Objective This study analyzed the clinical data of patients with synchronous double primary lung cancers(sDPLC),and aimed to further explore the clinical features,diagnosis,treatment methods and clinical application of next-generation sequencing technology(NGS)of sDPLC.Methods All clinical data of 89 patients with sDPLC admitted to the First Affiliated Hospital of Zhengzhou University from January 1,2015 to December 31,2019 were collected.The clinical characteristics,surgical methods,detection results of lung cancer driving genes and survival of patients were analyzed.Results All 89 patients with 178 lesions,the majority of the lesions located in the ipsilateral lobes(61/89,68.54%),the right upper lobe was the most common(52/178,29.21%),and adenocarcinoma was the most common type of pathology(167/178,93.82%).There were far more patients with the same pathological type(78/89,87.64%)than different ones(11/89,12.36%).The main surgical method was lobe-wedge resection(45/89,50.56%).38.76%(69/178)lesions were detected for lung cancer driving genes,and the mutation rate was 86.96%(60/69).The EGFR 21 exon L858R mutation was the most common(24/60,40.00%).Univariate survival analysis showed that smoking history(P=0.033),lymph node metastasis(P<0.001),different pathological types(P=0.046),the highest TNM stageⅡ~Ⅲ(P<0.001),and pleural invasion(P=0.015)were the poor prognostic factors of sDPLC.Multivariate survival analysis showed that patients with the same pathological type had better prognosis than patients with different pathological types(P=0.030),patients without lymph node metastasis had better prognosis than patients with metastasis(P=0.045),patients without pleural invasion had better prognosis than patients with invasion(P=0.048).The 1-,3-and 4-year DFS were 94.50%,89.00%and 66.70%respectively,and the median DFS was 48.84 months.Conclusion sDPLC mainly occurred in the upper lobe of the right lung,and the pathological types were mainly adenocarcinoma.Patients with lymph node metastasis,pleural invasion,relatively late stage,smoking history,and different pathological types have a relatively poor prognosis.Early diagnosis,active surgical treatment and smoking cessation can improve the prognosis of patients with sDPLC.