Nakata Masao, Sawada Shigeki, Yamashita Motohiro, Saeki Hideyuki, Kurita Akira, Takashima Shigemitsu, Tanemoto Kazuo
Department of Surgery, National Shikoku Cancer Center, Ehime, Japan.
Ann Thorac Surg. 2004 Oct;78(4):1194-9. doi: 10.1016/j.athoracsur.2004.03.102.
The aim of this study was to identify the clinical characteristics of multiple primary adenocarcinomas and to evaluate the efficacy of surgical treatments.
Three-hundred sixty-nine patients who underwent pulmonary resection for adenocarcinoma from January 1994 to December 2002 were reviewed.
Thirty-one patients (8.4%) were determined to have multiple primary adenocarcinomas that could be detected on chest x-rays or computed tomography (CT). Twenty-six patients were synchronous and five patients were metachronous with a median interval of 59.0 months. Forty-nine (72.1%) of the total 68 lesions exhibited ground-glass opacity on high-resolution CT (HRCT). Pathologically well-differentiated adenocarcinoma with mixed bronchioloalveolar pattern was the most common subtype (39.7%). Taking into consideration pulmonary function, size, location, and HRCT findings of the lesions the procedures performed were lobectomy with mediastinal lymph-node dissection for 32 patients, segmentectomy with hilar node dissection for 8 patients, and wedge resection for 28 patients. Of 17 patients with bilateral synchronous cancers, simultaneous bilateral pulmonary resection was performed in 14 patients including simultaneous bilateral video-assisted thoracic surgery (VATS) in 11 patients. After a median follow-up period of 27.7 months, the 3-year overall survival rate was 92.9% and the 3-year disease-free survival rates of synchronous cancer and metachronous cancer were 77.9% and 100%, respectively.
The incidence of multiple primary adenocarcinomas was relatively common. Early radiographic detection and surgical excision could yield a favorable prognosis. The use of VATS, even for synchronous bilateral patients, was a safe and beneficial procedure.
本研究旨在明确多原发性腺癌的临床特征，并评估外科治疗的疗效。
回顾了1994年1月至2002年12月期间因腺癌接受肺切除术的369例患者。
31例患者（8.4%）被确定患有可通过胸部X线或计算机断层扫描（CT）检测到的多原发性腺癌。26例为同时性，5例为异时性，中位间隔时间为59.0个月。68个病灶中49个（72.1%）在高分辨率CT（HRCT）上表现为磨玻璃影。病理上以混合细支气管肺泡型为主的高分化腺癌是最常见的亚型（39.7%）。根据病变的肺功能、大小、位置及HRCT表现，32例行肺叶切除加纵隔淋巴结清扫术，8例行肺段切除加肺门淋巴结清扫术，28例行楔形切除术。17例双侧同时性癌患者中，14例接受了同期双侧肺切除术，其中11例为同期双侧电视辅助胸腔镜手术（VATS）。中位随访27.7个月后，3年总生存率为92.9%，同时性癌和异时性癌的3年无病生存率分别为77.9%和100%。
多原发性腺癌的发生率相对较高。早期影像学检测及手术切除可带来良好预后。VATS的应用，即使对于双侧同时性患者也是安全有益的手术。
