Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
J Thorac Oncol. 2010 Jul;5(7):1018-24. doi: 10.1097/JTO.0b013e3181dd0fb0.
Multiple synchronous non-small cell lung cancers (NSCLCs) without extrathoracic metastasis are relatively uncommon. Some patients are treated as metastatic disease by chemotherapy alone; others are treated as multiple primary cancers by surgery. For those undergoing surgery, limited information exists on the relationship between tumor size and survival.
We retrospectively reviewed medical records of patients with resection of at least two synchronous NSCLC located in > or =2 lobes during 1997-2008. Those with only satellite nodules in single lobe were excluded. Cox proportional hazard model was used to examine the prognostic significance of tumor size in the context of other clinical parameters including tumor stage, nodal stage, age, gender, laterality, histology, and pneumonectomy.
There were 116 patients: 57 patients had cancers distributed in one lung and 59 in both lung. Overall, 186 thoracotomies were performed, with a 90-day mortality rate of 2.6%. The median overall survival was 65.1 months (95% confidence interval [CI]: 49.2-83.7). The median size of the largest tumor and the median sum of tumor sizes were 3.0 and 4.5 cm, respectively. Both were a significant predictor of survival: hazard ratios per centimeter increase where 1.17 (95% CI: 1.06-1.30, p = 0.003) and 1.15 (95% CI: 1.05-1.26, p = 0.003), respectively. Multivariable regression analysis identified tumor size and lung function as independent survival predictors.
Among patients with resected multiple synchronous NSCLC, tumor size is an independent predictor of survival. The size of the largest tumor performs slightly better than the sum of tumor sizes in the survival prediction; however, both are much better than the American Joint Committee on Cancer stage for this purpose.
多个无胸外转移的非小细胞肺癌（NSCLC）同步发生较为少见。一些患者仅接受化疗治疗，被视为转移疾病；另一些患者则通过手术治疗，被视为多个原发性癌症。对于接受手术的患者，关于肿瘤大小与生存之间关系的信息有限。
我们回顾性分析了 1997 年至 2008 年间至少两个位于>或=2 个肺叶的同步 NSCLC 切除患者的病历。仅在单个肺叶存在卫星结节的患者被排除在外。使用 Cox 比例风险模型来检查肿瘤大小在肿瘤分期、淋巴结分期、年龄、性别、侧别、组织学和全肺切除等其他临床参数背景下的预后意义。
共有 116 例患者：57 例患者的癌症分布在单侧肺，59 例患者的癌症分布在双侧肺。共有 186 例患者接受了开胸手术，90 天死亡率为 2.6%。中位总生存期为 65.1 个月（95%置信区间[CI]：49.2-83.7）。最大肿瘤的中位大小和肿瘤总大小的中位值分别为 3.0cm 和 4.5cm。两者均是生存的显著预测因素：每增加 1cm 的风险比分别为 1.17（95%CI：1.06-1.30，p=0.003）和 1.15（95%CI：1.05-1.26，p=0.003）。多变量回归分析确定肿瘤大小和肺功能是独立的生存预测因素。
在接受切除的多个同步 NSCLC 患者中，肿瘤大小是生存的独立预测因素。最大肿瘤的大小在生存预测中略优于肿瘤总大小，但两者均优于美国癌症联合委员会分期。
