同时性多原发肺癌的预后及生存相关因素研究

发布时间：2018-08-11 11:02

【摘要】：背景与目的同时性多原发肺癌(synchronous multiple primary lung cancer,sMPLC)既往属少见疾病,近年发病率呈持续上升趋势,但缺乏对其大样本的研究报道。本研究对357例s MPLC的临床病理资料进行分析总结,籍以为临床诊断、治疗及预后提供理论依据。方法参考Martini-Melamed诊断标准和国际肺癌研究协会(International Association for the Study of Lung Cancer,IASLC)第8版肿瘤-淋巴结-转移(tumor-node-metastasis,TNM)分期标准,对357例sMPLC的临床病理资料进行分析。结果 357例患者中,双原发病灶269例(75.35%),三原发病灶65例(18.21%),四原发病灶及以上者23例(6.44%),最多者为8个病灶。病灶好发于上叶,特别是右上叶(35.77%,298/833),病理类型以腺癌为主(95.56%,796/833),鳞癌次之(2.40%,20/833),腺癌亚型中以腺泡样为主的比例较高(70.81%,313/442),分期以Ib期及以下为主(68.35%,244/357)。病理类型相同者发病率(92.72%,331/357)远高于不同病理类型(7.28%,26/357),其中腺癌-腺癌比例较高(99.40%,329/331)。sMPLC的3年总生存率(overall survival,OS)为91.93%,5年总生存率为84.37%,多因素生存分析显示,有吸烟史(P=0.012)、最大病灶直径大于2 cm(P=0.027)、淋巴结转移(P=0.015)和胸膜受累(P0.001)为影响sMPLC预后生存的独立危险因素。结论 sMPLC好发于右上叶,以腺癌最常见,腺泡样为主的亚型多见。吸烟史、最大结节直径、淋巴结转移和胸膜侵犯是影响sMPLC预后生存的独立危险因素。早期发现和积极的手术可以使sMPLC患者获得较好的预后。
[Abstract]:Background & objective simultaneous multiple primary lung cancer (synchronous multiple primary lung cancer MPLC) is a rare disease in the past. The incidence of MPLCs has been increasing in recent years, but there is no report on its large sample. In this study, the clinicopathological data of 357 cases of s MPLC were analyzed and summarized to provide theoretical basis for clinical diagnosis, treatment and prognosis. Methods according to the diagnostic criteria of Martini-Melamed and tumor-node-lymph node metastasis (TNM) staging criteria of (International Association for the Study of Lung Cancer IASLC, the clinicopathological data of 357 cases of sMPLC were analyzed. Results among 357 patients, 269 cases (75.35%) had double primary lesions, 65 cases (18.21%) had three primary lesions, 23 cases (6.44%) had four or more primary lesions, and 8 lesions were the most common. The lesions mainly occurred in the upper lobe, especially in the right superior lobe (35.7778 / 833). The pathological types were mainly adenocarcinoma (95.56A / 796 / 833), squamous cell carcinoma (2.40C / 20 / 833), acinar subtype (70.81313 / 442), and stage Ib (68.35 / 24447). The incidence rate of the same pathological type (92.72and 331- 357) was much higher than that of the different pathological types (7.280.26 / 357), in which the ratio of adenocarcinoma to adenocarcinoma was higher (99.4040 / 329 / 331) .sMPLC had a overall survival OS of 91.93, and a 5-year overall survival rate of 84.377.Multivariate survival analysis showed that Smoking history (P0. 012), maximum lesion diameter more than 2 cm (P0. 027), lymph node metastasis (P0. 015) and pleural involvement (P0. 001) were independent risk factors for the survival of sMPLC. Conclusion sMPLC usually occurs in the upper right lobe, adenocarcinoma is the most common and acinar subtype is more common. Smoking history, maximum nodule diameter, lymph node metastasis and pleural invasion were independent risk factors for survival of sMPLC. Early detection and active surgery can lead to better prognosis in patients with sMPLC.
【作者单位】：上海交通大学附属胸科医院/上海市肺部肿瘤临床医学中心;
【分类号】：R734.2

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