Thoracic Surgery Unit, University Hospital of Siena, Viale Mario Bracci, 1, 53100, Siena, Italy.
Eur J Cardiothorac Surg. 2010 May;37(5):1198-204. doi: 10.1016/j.ejcts.2009.11.025. Epub 2009 Dec 21.
The International Association for Study of Lung Cancer Staging Committee proposes for the next revision of TNM (tumour, nodes, metastases) classification that additional nodules in a different lobe of the ipsilateral lung moves from an M1 designation to T4, while additional nodule(s) in the contralateral lung should be classified as M1a, because of poorer survival. We analysed the survival after surgery of patients presenting with synchronous lung cancers located in a different lobe or lung.
A database of 1551 patients operated on for non-small-cell lung cancer (NSCLC) between 1990 and 2007 was evaluated for unilateral (other lobe) (n=15) and bilateral (n=28) synchronous multiple lung cancers. The relationships among the location of tumours, histology, date of surgery (before and after 2000), lymph node metastasis, type of surgery, adjuvant therapy and survival were analysed.
The 5-year survival for all synchronous multiple lung cancers (n=43) was 34%, with a median survival of 32 months. Postoperative mortality was 7%. On univariate analysis, only lymph node metastasis and surgery before the year 2000 affected the overall survival adversely, and both prognostic factors maintained a statistical significance on multivariate analysis. The 5-year survivals were 57% and 0% for patients without (n=25) and with (n=18) lymph node metastasis, respectively (p=0.004), and were 43% and 18% for patients operated upon after (n=27) and before (n=16) the year 2000, respectively (p=0.01), perhaps reflecting a better selection process related to the extensive use of positron emission tomography (PET) scanning. The 5-year survival was not different between bilateral (43%) and unilateral (27%) synchronous lung cancers (p=n.s.).
Our data support complete surgical resection of synchronous multiple lung cancers in patients with node-negative NSCLC. Even patients with bilateral lung cancer should not be treated as metastatic disease. Provided there is no evidence of node and distant metastasis, after an extensive preoperative work-up, including PET scanning and mediastinoscopy, bilateral surgical resection should be performed in fit patients.
国际肺癌研究协会分期委员会提议，在下一次 TNM（肿瘤、淋巴结、转移）分类修订中，同侧肺不同叶的额外结节从 M1 分类转移到 T4，而对侧肺的额外结节应归类为 M1a，因为前者的生存率较差。我们分析了手术治疗的同时性肺癌患者的生存情况，这些患者的肺癌位于不同的肺叶或肺部。
我们评估了 1990 年至 2007 年间接受非小细胞肺癌（NSCLC）手术的 1551 例患者的数据库，其中单侧（其他叶）（n=15）和双侧（n=28）同时性多发性肺癌。分析了肿瘤位置、组织学、手术日期（2000 年前和后）、淋巴结转移、手术类型、辅助治疗与生存之间的关系。
所有同时性多发性肺癌（n=43）的 5 年生存率为 34%，中位生存时间为 32 个月。术后死亡率为 7%。单因素分析表明，只有淋巴结转移和 2000 年前的手术是总生存的不利因素，这两个预后因素在多因素分析中仍然具有统计学意义。无淋巴结转移（n=25）和有淋巴结转移（n=18）患者的 5 年生存率分别为 57%和 0%（p=0.004），2000 年后手术（n=27）和 2000 年前手术（n=16）患者的 5 年生存率分别为 43%和 18%（p=0.01），这可能反映了与广泛使用正电子发射断层扫描（PET）扫描相关的更好的选择过程。双侧（43%）和单侧（27%）同时性肺癌的 5 年生存率无差异（p=n.s.）。
我们的数据支持对无淋巴结转移的 NSCLC 患者的同时性多发性肺癌进行完全手术切除。即使是双侧肺癌患者也不应被视为转移性疾病。只要没有淋巴结和远处转移的证据，在广泛的术前检查（包括 PET 扫描和纵隔镜检查）后，应在合适的患者中进行双侧手术切除。
