Stenbygaard L E, Sørensen J B
Department of Oncology, Copenhagen University Hospital Herlev, Denmark.
Lung Cancer. 1999 Nov;26(2):95-101. doi: 10.1016/s0169-5002(99)00075-6.
A case report of stage I adenocarcinoma of the lung in a 43-year-old female with recurrence in the small bowel and liver 11 months after pneumonectomy is presented. In addition, a cohort of 733 patients with non-small cell lung cancer (NSCLC) in all pretreatment stages (stages I-IV) with a total of 218 autopsies are evaluated, and the literature on the topic is reviewed, in order to define the frequency of metastases from NSCLC to the small bowel. There were 10 cases with and 208 cases without small bowel involvement among 218 consecutive autopsies (autopsy rate, 30%,). The frequency of small bowel involvement was 4.6% (95%, confidence interval, 2.2-8.3%), and all were in patients with adenocarcinoma of the lung. All patients with small bowel involvement at autopsy had also other concurrent metastatic sites as well and the following were the most frequent: adrenals (90%, of cases), mediastinal lymph nodes (80%), liver (70%), pleura (60%), contralateral lung (60%), bones (60%), and brain (50%). Significantly more metastatic sites were observed in patients with than without small bowel involvement, both totally (P = 0.0001) and with respect to number of extrathoracic (P = 0.0001) and intrathoracic (P = 0.01) metastatic sites. In conclusion, small bowel involvement in NSCLC is relatively infrequent. As a unique finding, over-representation of patients with poorly differentiated tumors (P = 0.03) and patients having solid carcinoma with mucus formation after histologic subtyping (P = 0.04) among cases with small bowel involvement was observed. This indicates, that small bowel metastases is an epiphenomonen of NSCLC tumors with certain biological characteristics, although as yet undiscovered, which leads to a high metastatic potential. If such biological characteristics could be identified, they may be used in the selection of treatment options for individual patients, e.g. indicating a need for adjuvant or neoadjuvant chemotherapy in addition to surgery in resectable or marginally resectable NCSLC patients.
本文报告了一例43岁女性肺I期腺癌患者，在肺切除术后11个月出现小肠和肝脏复发的病例。此外，对733例处于所有预处理阶段（I - IV期）的非小细胞肺癌（NSCLC）患者进行了评估，共进行了218例尸检，并回顾了该主题的文献，以确定NSCLC转移至小肠的频率。在218例连续尸检中，有10例小肠受累，208例未受累（尸检率为30%）。小肠受累的频率为4.6%（95%置信区间为2.2 - 8.3%），且所有受累患者均为肺腺癌患者。所有尸检时小肠受累的患者同时还存在其他转移部位，最常见的如下：肾上腺（90%的病例）、纵隔淋巴结（80%）、肝脏（70%）、胸膜（60%）、对侧肺（60%）、骨骼（60%）和脑（50%）。与小肠未受累的患者相比，小肠受累患者观察到的转移部位明显更多，无论是总的转移部位数量（P = 0.0001），还是胸外（P = 0.0001）和胸内（P = 0.01）转移部位的数量。总之，NSCLC累及小肠相对少见。作为一个独特的发现，在小肠受累的病例中，观察到低分化肿瘤患者（P = 0.03）和组织学亚型为实体癌伴黏液形成的患者（P = 0.04）比例过高。这表明，小肠转移是具有某些尚未发现的生物学特征的NSCLC肿瘤的一种附带现象，这些特征导致了高转移潜能。如果能够识别出这些生物学特征，它们可能会被用于为个体患者选择治疗方案，例如表明可切除或边缘可切除的NSCLC患者除手术外还需要辅助或新辅助化疗。
