Oliaro Alberto, Filosso Pier Luigi, Cavallo Antonio, Giobbe Roberto, Mossetti Claudio, Lyberis Paraskevas, Cristofori Riccardo Carlo, Ruffini Enrico
Department of Thoracic Surgery, University of Torino, Ospedale Molinette, Via Genova 3, Turin, Italy.
Eur J Cardiothorac Surg. 2008 Aug;34(2):438-43; discussion 443. doi: 10.1016/j.ejcts.2008.03.070. Epub 2008 May 27.
The management of patients with non-small cell lung cancer (NSCLC) with intrapulmonary metastases (PM) is controversial. In TNM classification, PM are designed as T4 when in the same lobe of the primary tumour (PM1) and M1 when in a different lobe(s) (PM2). Some authors have questioned the negative prognostic impact of PM. The present study assessed prevalence, correlation with clinico-pathologic variables and impact on survival of PM, along with a review of the literature.
From January 1993 to December 2006, 2013 NSCLC patients underwent surgical resection at our institution. Of these, 74 presented with PM (39 PM1, 35 PM2). Patients with bronchioloalveolar carcinoma (BAC), carcinoid tumours, contralateral disease and preoperative chemo/radiotherapy were excluded from the analysis. A logistic regression analysis was undertaken to evaluate a relationship between the presence of PM and different clinico-pathologic variables. Survival analysis was undertaken to investigate the prognostic significance of PM.
PM represent 3.6% of our patient population of operated NSCLC. Metastases were multiple in 36 cases and single in 38. Thirty-six patients had node-negative disease. Among all the variables for the logistic regression analysis only vascular invasion (OR: 0. 45; 95% CI 0.24-0.85, p=0.01) and N status (OR: 0. 6; 95% CI 0.43-0.82, p=0.001) were significantly correlated with the presence of PM. Median survival rates of PM1, PM2, other T4 and other M1 patients were 25, 23, 15 and 14 months, respectively. A survival advantage was observed in patients with PM as compared to other T4/M1 patients, although the difference was not significant either overall (p=0.21) or in the N0 disease group (p=0.12).
The presence of PM in NSCLC patients is a rare occurrence. Risk factors for the development of PM are a microscopic vascular invasion and a high nodal status. A survival advantage over other T4/M1 patients is evident from our experience, although not significant. The results of the literature which have been accumulating in the most recent years including ours bend to the conclusion that there is sufficient validated information to consider a downstaging in the presence of intrapulmonary metastases from NSCLC for the seventh edition of the TNM classification.
非小细胞肺癌（NSCLC）伴肺内转移（PM）患者的管理存在争议。在TNM分类中，当转移灶位于原发肿瘤的同一肺叶时（PM1），PM被定义为T4，当位于不同肺叶时（PM2），则被定义为M1。一些作者对PM的不良预后影响提出了质疑。本研究评估了PM的发生率、与临床病理变量的相关性及其对生存的影响，并对相关文献进行了综述。
1993年1月至2006年12月，2013例NSCLC患者在我院接受了手术切除。其中，74例出现PM（39例PM1，35例PM2）。细支气管肺泡癌（BAC）、类癌肿瘤、对侧病变及术前接受化疗/放疗的患者被排除在分析之外。采用逻辑回归分析评估PM的存在与不同临床病理变量之间的关系。进行生存分析以研究PM的预后意义。
PM占我们接受手术的NSCLC患者群体的3.6%。转移灶为多发的有36例，单发的有38例。36例患者无淋巴结转移。在逻辑回归分析的所有变量中，只有血管侵犯（OR：0.45；95%CI 0.24 - 0.85，p = 0.01）和N分期（OR：0.6；95%CI 0.43 - 0.82，p = 0.001）与PM的存在显著相关。PM1、PM2、其他T4和其他M1患者的中位生存率分别为25个月、23个月、15个月和14个月。与其他T4/M1患者相比，PM患者观察到生存优势，尽管总体差异不显著（p = 0.21），在N0疾病组中差异也不显著（p = 0.12）。
NSCLC患者中PM的存在较为罕见。PM发生的危险因素是微小血管侵犯和高淋巴结分期。从我们的经验来看，与其他T4/M1患者相比有生存优势，尽管不显著。近年来积累的包括我们研究在内的文献结果倾向于得出这样的结论：有足够的有效信息支持在TNM分类第七版中考虑对存在NSCLC肺内转移的情况进行降期。
