Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
Ann Thorac Surg. 2013 Mar;95(3):1000-5. doi: 10.1016/j.athoracsur.2012.11.072. Epub 2013 Jan 31.
Patients with a history of previous malignancy are often encountered in a discussion of surgical resection of non-small-cell lung cancer (NSCLC). The outcome of patients with 2 or more previous cancers remains unknown.
We performed a retrospective study including all patients undergoing resection for NSCLC from January 1980 to December 2009 at 2 French centers. We then compared the survival of patients without a history of another cancer (group 1), those with a history of a single malignancy (group 2), and those with a history of 2 or more previous malignancies (group 3).
There were 5,846 patients: 4,603 (78%) in group 1, 1,147 (20%) in group 2, and 96 (2%) in group 3. The proportion of patients included in group 3 increased from 0.3% to 3% over 3 decades. Compared with groups 1 and 2, group 3 was associated with older age, a larger proportion of women, earlier tumor stage, less induction therapy, and fewer pneumonectomies. Despite this, postoperative complications and mortality were similar in groups 2 and 3, and higher than in group 1. Five-year survival rates were 44.6%, 35.1%, and 23.6% in groups 1, 2, and 3, respectively (p < 0.000001 for comparison between 3 groups; p = 0.18 for comparison between groups 2 and 3). In multivariate analysis, male sex, higher T stage, higher N stage, incomplete resection, and study group were significant predictors of adverse prognosis.
Despite earlier diagnosis and acceptable long-term survival, patients operated on for NSCLC after 2 or 3 previous malignancies carried a worse prognosis than did those undergoing operation after 1 malignancy or if there was no previous diagnosis of cancer.
在讨论非小细胞肺癌（NSCLC）的手术切除时，经常会遇到有既往恶性肿瘤病史的患者。有 2 次或更多次既往癌症史的患者的结局尚不清楚。
我们进行了一项回顾性研究，纳入了 1980 年 1 月至 2009 年 12 月在法国 2 个中心接受 NSCLC 切除术的所有患者。然后，我们比较了无另一癌症病史的患者（第 1 组）、有单一致癌病史的患者（第 2 组）和有 2 次或更多次既往恶性肿瘤病史的患者（第 3 组）的生存情况。
共有 5846 例患者：第 1 组 4603 例（78%），第 2 组 1147 例（20%），第 3 组 96 例（2%）。第 3 组患者的比例在 30 年内从 0.3%增加到 3%。与第 1 组和第 2 组相比，第 3 组患者年龄较大，女性比例较高，肿瘤分期较早，诱导治疗较少，全肺切除术较少。尽管如此，第 2 组和第 3 组的术后并发症和死亡率与第 1 组相似，且高于第 1 组。第 1 组、第 2 组和第 3 组的 5 年生存率分别为 44.6%、35.1%和 23.6%（组间比较 P<0.000001；组间比较 P=0.18）。多因素分析显示，男性、较高的 T 分期、较高的 N 分期、不完全切除和研究组是预后不良的显著预测因素。
尽管诊断较早且长期生存可接受，但与仅患有 1 次恶性肿瘤或无既往癌症诊断的患者相比，因 2 次或 3 次既往恶性肿瘤而接受 NSCLC 手术的患者预后较差。
