同时性多原发肺腺癌的外科治疗及预后

发布时间：2018-05-11 19:41

本文选题：肺肿瘤 + 表皮生长因子受体　；参考：《中国肺癌杂志》2017年02期

【摘要】：背景与目的随着高分辨率计算机断层扫描(high-resolution computed tomography,HRCT)应用的普及,多原发肺癌(multiple primary lung cancers,MPLC)的检出率逐年上升,其中腺癌是最常见的病理类型。目前国内外对MPLC的研究已相对多见,但罕有单独分析同时性多原发肺腺癌(synchronous multiple primary lung adenocarcinomas,SMPLA)的报道。本研究探讨SMPLA患者的临床病理特点及预后,旨在提高对SMPLA的认识。方法对2012年12月-2016年7月期间我科38例临床资料保存完整的SMPLA患者进行了回顾性分析。结果 38例SMPLA患者中,男性12例,女性26例,中位年龄为58岁(39岁-73岁)。双原发肺腺癌29例,2个病灶以上9例。病灶位于同侧26例,双侧12例。同期手术34例(包括8例患者同期行双侧手术),分期手术4例。5例患者对每个病灶分别行基因检测,结果证实不同病灶的表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变类型不完全相同。1年和3年总生存率分别为96.6%和74.2%。肿瘤直径越大(P0.001)、T分期越高(P=0.003)、淋巴结转移(P=0.001)、TNM分期越高(P=0.022)以及术后放、化疗(P=0.009)提示总生存预后较差。结论对于多发的非小细胞肺癌,不能轻易地诊断为转移癌,应考虑多原发可能。EGFR基因检测可作为鉴别多原发肺腺癌与复发转移癌的临床参考。
[Abstract]:Background and objective with the popularization of high-resolution computed tomography (HRCT), the detection rate of multiple primary lung cancer (MPLCs) has increased year by year, among which adenocarcinoma is the most common pathological type. At present, there have been many studies on MPLC at home and abroad, but there are few reports on simultaneous analysis of synchronous multiple primary lung adenocarcinoma. The aim of this study was to investigate the clinicopathological features and prognosis of SMPLA patients and to improve the understanding of SMPLA. Methods from December 2012 to July 2016, 38 SMPLA patients with complete clinical data were retrospectively analyzed. Results among 38 patients with SMPLA, 12 were male and 26 were female. The median age was 58 years old, 39 to 73 years old. There were 29 cases with double primary lung adenocarcinoma and 9 cases with more than 2 lesions. The lesions were located ipsilateral in 26 cases and bilateral in 12 cases. 34 patients underwent simultaneous operation (including 8 patients underwent bilateral surgery at the same time, 4 patients underwent staging surgery, and 5 patients underwent gene detection for each lesion, respectively). The results showed that epidermal growth factor receptor EGFR gene mutation types were not the same in different lesions, and the 1-year and 3-year overall survival rates were 96.6% and 74.2%, respectively. The larger the diameter of the tumor, the higher the P0.001T stage, the higher the P0. 003, the higher the P0. 001 / TNM stage of lymph node metastasis, the higher the P0. 022) and the postoperative radiotherapy, chemotherapy, P0. 009) suggesting that the overall survival and prognosis are poor. Conclusion for multiple non-small cell lung cancer, it is not easy to diagnose metastatic carcinoma. It should be considered that the detection of .EGFR gene in multiple primary lung cancer can be used as a clinical reference for differentiating multiple primary lung adenocarcinoma from recurrence and metastasis.
【作者单位】：山东大学附属省立医院胸外科;
【基金】：山东省科技发展项目基金(No.2012GSF11826)资助~~
【分类号】：R734.2

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