Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Lung Cancer. 2011 Jun;72(3):303-8. doi: 10.1016/j.lungcan.2010.09.014. Epub 2010 Oct 30.
To assess risk of lung cancer (LC) in patients with preinvasive bronchial lesions and to identify factors associated with higher risk.
124 patients with one or more preinvasive bronchial lesions and normal chest computed tomography (CT) (mean age 66.7 years, 121 males and 3 females), followed-up by white light and autofluorescence bronchoscopy (AFB) every 4-6 mo and chest CT every 6-12 mo, end points were development of carcinoma in situ (CIS) or LC.
Among 124 patients with 240 preinvasive bronchial lesions, 20 CIS or LC lesions were detected during follow-up in 20 (16%) patients, 7 were detected as new endobronchial lesions, 10 as new peripheral lesions and 3 as local progression from severe dysplasia to CIS. Median time to progression from the same site or development of CIS/LC elsewhere was 24 months (range: 6-54 mo). The Cumulative risk of development of CIS/LC was 7% at one year, 20% at three years and 44% at 5 years. Among detected lung cancers, 80% were stage 0 or stage I and underwent treatment with curative intent. Diagnosis of new SD during follow-up (p=0.0001), chronic obstructive pulmonary disease (COPD) (p=0.001) or smoking index >52 pack-year (p=0.042) was associated with higher risk. Even after controlling for other risk factors, COPD was associated with risk for lung cancer. Baseline lesion grade was not predictive of patient outcome (p=0.146).
Patients with preinvasive bronchial lesions, especially those with new SD during follow-up, COPD or smoking >52 pack-year are at high risk of LC, AFB and CT follow-up facilitated early detection and treatment with curative intent.
评估有支气管上皮内瘤变患者罹患肺癌（LC）的风险，并识别与更高风险相关的因素。
124 例存在 1 个或多个支气管上皮内瘤变且胸部 CT 正常的患者（平均年龄 66.7 岁，121 例男性，3 例女性），每 4-6 个月行白光支气管镜和自体荧光支气管镜（AFB）检查，每 6-12 个月行胸部 CT 检查，终点事件为原位癌（CIS）或 LC 的发生。
在 124 例患者的 240 处支气管上皮内瘤变中，20 例患者在随访中发现 20 处 CIS 或 LC 病变，其中 7 处为新的支气管内病变，10 处为新的周围病变，3 处为重度异型增生进展为 CIS 的局部病变。同一部位进展或其他部位发生 CIS/LC 的中位时间为 24 个月（范围：6-54 个月）。从同一位点或其他部位发生 CIS/LC 的累积风险在 1 年时为 7%，3 年时为 20%，5 年时为 44%。在检出的肺癌中，80%为 0 期或 1 期，接受了根治性治疗。随访中新诊断出的 SD（p=0.0001）、慢性阻塞性肺疾病（COPD）（p=0.001）或吸烟指数>52 包年（p=0.042）与更高的风险相关。即使在控制了其他危险因素后，COPD 与肺癌的发生风险相关。基线病变分级与患者预后无关（p=0.146）。
有支气管上皮内瘤变的患者，尤其是随访中新诊断出 SD、COPD 或吸烟>52 包年的患者，发生 LC 的风险较高，AFB 和 CT 随访有助于早期发现并进行根治性治疗。
