Trousse Delphine, Barlesi Fabrice, Loundou Anderson, Tasei Anne Marie, Doddoli Christophe, Giudicelli Roger, Astoul Philippe, Fuentes Pierre, Thomas Pascal
Department of Thoracic Surgery, Sainte Marguerite University Hospital, Marseille, France.
J Thorac Cardiovasc Surg. 2007 May;133(5):1193-200. doi: 10.1016/j.jtcvs.2007.01.012.
No guidelines detailing recommendations for the selection and treatment of patients with synchronous multiple primary lung cancer have been published. We report on a single-institution experience with synchronous multiple primary lung cancer, with emphasis on long-term survival.
We performed a retrospective study of 125 consecutive patients with synchronous multiple primary lung cancer who underwent operation between 1985 and 2006. Various treatment strategies were applied, including perioperative therapy. Potential prognosticators were submitted to univariate and multivariate analyses.
Tumors were bilateral (n = 34) or ipsilateral (n = 91). Optimal surgical treatment (complete anatomic resection with radical lymphadenectomy) was possible in 65.6% of the cases. pN0 disease was present in 32.3% of the patients; 30-day and 90-day mortality rates were 4.5% and 11%, respectively. Two- and 5-year overall survivals were 61.6% and 34%, respectively, with a median survival of 35 months. On univariate analysis, smoking status, high Charlson index, low forced expiratory volume in 1 second, occurrence of postoperative complications, and performance of a pneumonectomy affected the overall survival adversely. Conversely, bilateral disease, location in the same lobe, and pN0 disease were favorable prognosticators. On multivariate analysis, low forced expiratory volume in 1 second, nonoptimal surgical treatment, and performance of a pneumonectomy were independent predictors of poor long-term survival, whereas female sex, younger age, asymptomatic disease, pN0 status, and performance of an adjuvant treatment affected the survival favorably.
Provided there is an appropriate selection process, patients with synchronous multiple primary lung cancer are expected to benefit from surgery. Optimal surgery should be performed, but pneumonectomy should be avoided whenever possible. Adjuvant treatment is suggested to provide an added survival advantage.
目前尚无关于同步性多原发性肺癌患者选择和治疗建议的详细指南发表。我们报告了单机构同步性多原发性肺癌的治疗经验，重点关注长期生存情况。
我们对1985年至2006年间连续125例行手术治疗的同步性多原发性肺癌患者进行了回顾性研究。采用了包括围手术期治疗在内的各种治疗策略。对潜在的预后因素进行单因素和多因素分析。
肿瘤为双侧性（n = 34）或同侧性（n = 91）。65.6%的病例可行最佳手术治疗（完整解剖切除并根治性淋巴结清扫）。32.3%的患者为pN0期疾病；30天和90天死亡率分别为4.5%和11%。2年和5年总生存率分别为61.6%和34%，中位生存期为35个月。单因素分析显示，吸烟状况、高Charlson指数、低第1秒用力呼气量、术后并发症的发生以及全肺切除术的实施对总生存有不利影响。相反，双侧疾病、位于同一肺叶以及pN0期疾病是有利的预后因素。多因素分析显示，低第1秒用力呼气量、非最佳手术治疗以及全肺切除术的实施是长期生存不良的独立预测因素，而女性、年龄较轻、无症状疾病、pN0状态以及辅助治疗的实施对生存有有利影响。
如果有适当的选择过程，同步性多原发性肺癌患者有望从手术中获益。应进行最佳手术，但应尽可能避免全肺切除术。建议辅助治疗以提供额外的生存优势。
