Horinouchi H, Yamamoto M, Goto T, Koyama T, Kamiyama I, Yamauchi N, Horiguchi H, Otsuka T, Inoue Y, Iwamaru Y, Abiko T, Sawafuji M, Watanabe M, Kawamura M, Kobayashi K
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
Kyobu Geka. 2002 Jan;55(1):45-50.
Synchronous and metachronous lung cancer is occasionally encountered. Frequency of the occurrence is increasing because of recent progress of imaging technique such as high resolution CT and CT based annual lung survey. We analyzed clinical characteristics of both synchronous and metachronous lung cancer treated surgically in our facility. There were 20 cases of multiple lung cancer cases, which is consisted of 12 synchronous multiple lung cancer cases and 8 metachronous lung cancer cases. Mean age was 62 years old and there were 14 male and 6 female cases. Among synchronous group, 8 cases have multiple shadow in ipsilateral hemithorax and 4 cases in both side. Surgery was carried out according to the extent of the disease and lung reserve. Associated cancer was diagnosed stage IA or IB in all cases. Five-year survival was 58.9%. Meanwhile, as regards to metachronous group, mean interval between first cancer and second cancer was 73 months. Seven cases have contralateral second primary lung cancer and one case has ipsilateral second primary lung cancer. In 3 cases, histology of the first and the second disease were different and in 5 cases that were the same. The first procedures were complete resection with systemic mediastinal LN dissection. The second procedures were determined based on the lung reserve. Pathological stage of the second disease were either stage IA or IB. There were no operative mortality and 5 years survival was 75%. Since there is no operative mortality and the outcome seems satisfactory when the patient has enough lung reserve, aggressive surgical resection should be considered in the case of multiple primary lung cancer. There is an increasing chance of synchronous multiple primary lung cancer because of improvement of imaging system. We have to prepare new therapeutic strategy for those patients.
偶见同时性和异时性肺癌。由于高分辨率CT和基于CT的年度肺部筛查等成像技术的最新进展，其发生率正在上升。我们分析了在本机构接受手术治疗的同时性和异时性肺癌的临床特征。共有20例多原发性肺癌病例，其中包括12例同时性多原发性肺癌病例和8例异时性肺癌病例。平均年龄为62岁，男性14例，女性6例。在同时性组中，8例同侧半胸有多个阴影，4例双侧有多个阴影。根据疾病范围和肺储备情况进行手术。所有病例的相关癌症均诊断为IA期或IB期。5年生存率为58.9%。同时，对于异时性组，第一癌与第二癌的平均间隔时间为73个月。7例有对侧第二原发性肺癌，1例有同侧第二原发性肺癌。3例中，第一和第二种疾病的组织学不同，5例相同。第一次手术为完整切除并进行系统性纵隔淋巴结清扫。第二次手术根据肺储备情况确定。第二种疾病的病理分期为IA期或IB期。无手术死亡病例，5年生存率为75%。由于无手术死亡病例，且当患者有足够的肺储备时结果似乎令人满意，因此对于多原发性肺癌病例应考虑积极的手术切除。由于成像系统的改进，同时性多原发性肺癌的机会在增加。我们必须为这些患者制定新的治疗策略。
