Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Organ Transplant. 2012 Oct;17(5):479-84. doi: 10.1097/MOT.0b013e328357fff6.
Recent advances have led to improved outcomes in lung transplantation. The International Society for Heart and Lung Transplantation Registry data have shown a steady increase in the number of cases performed annually. Although somewhat controversial, lung transplantation (LTx) for lung cancer has also slowly increased. The current role of LTx for malignant diseases and the management challenge of incidental lung cancer in the explanted lungs are reviewed herein.
For a few particular scenarios (advanced multifocal bronchioloalveolar carcinoma causing chronic respiratory failure, end-stage lung disease concomitant with early stage lung cancer, and metastatic disease restricted to the lungs with the primary site controlled) in which nonsurgical alternatives fail to provide adequate palliation, LTx may be considered. Nevertheless, in order to achieve acceptable results, careful patient selection and staging are paramount. In patients with incidental bronchogenic carcinoma in the explanted lung following transplantation, the prognosis is mainly driven by the malignancy stage.
LTx can be performed to treat malignant diseases with results approaching those for nonneoplastic indications, given that patients are carefully selected and staged. Although they have not been widely applied in the reported lung transplant literature, modalities such as endobronchial ultrasound and positron emission tomography scan are strongly encouraged and have the potential to further refine staging in this population.
近年来，肺移植的疗效有所提高。国际心肺移植协会登记处的数据显示，每年进行的病例数量稳步增加。尽管存在一些争议，但肺癌的肺移植（LTx）也在缓慢增加。本文回顾了 LTx 治疗恶性疾病的当前作用，以及在移植肺中偶然发现的肺癌的管理挑战。
对于一些特殊情况（导致慢性呼吸衰竭的晚期多灶性细支气管肺泡癌、伴早期肺癌的终末期肺病和主要部位得到控制的肺部转移疾病），如果非手术方法无法提供充分的缓解，可考虑进行 LTx。然而，为了获得可接受的结果，仔细的患者选择和分期至关重要。在移植后切除的肺中偶然发现的支气管肺癌患者中，预后主要取决于恶性肿瘤的分期。
如果患者经过仔细选择和分期，LTx 可用于治疗恶性疾病，其结果可与非肿瘤适应证相近。尽管在已报道的肺移植文献中尚未广泛应用，但强烈鼓励使用支气管内超声和正电子发射断层扫描等方法，它们有可能进一步完善这一人群的分期。
