Stojiljkovic D, Mandaric D, Miletic N, Stojsic J, Markovic I, Gavrilovic D, Pupic G, Stojiljkovic T, Lukac B, Dzodic R
Department of Surgery, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia.
J BUON. 2013 Jan-Mar;18(1):169-75.
To investigate the correlation between stage and histopathological characteristics of patients with lung cancer and local recurrence, as well as the incidence and the characteristics of local recurrence along with the possibility of surgical retreatment.
Studied were 51 patients with locally relapsing lung cancer, initially treated surgically from 2003 to 2007. The operations performed ranged from conservative wedge resections, standard lobectomies and pneumonectomies to extensive resections of the entire lung and chest wall. All patients underwent regular follow-up including thoracic CT scan every 3 months.
All patients were diagnosed with local recurrence after a median of 10 months (range 1-30) after primary surgery with curative intent. There was no statistically significant link between type of surgery and time to local recurrence. Patients with pathological stage I,II, and IIIa had a significantly longer time to local recurrence than those with stage IIIb and IV. Local recurrence sites were the bronchial stump, mediastinal lymph nodes, the remaining lung parenchyma, chest wall and a combination of these. Surgical retreatment was possible in 20 of 51 patients (39.27percnt;). Chest wall was the commonest localization (20 of 51; 39.2%), also the most frequent in the group of surgically retreated patients (13 of 20; 65%). Squamous cell cancer (SCC) was the predominant histological type (38 of 51; 74.5%), followed by adenocarcinoma (9 of 51; 17.7%).
SCC is the commonest locally relapsing lung cancer. The type of the initial surgical procedure didn't have any impact on the incidence of local recurrence, but the extent and completeness of surgery did. The time to local recurrence heavily depended on the primary tumor pathological stage. Chest wall was the commonest relapse site, and the most suitable for surgical retreatment, which was related to the quality of surgery.
探讨肺癌患者分期与组织病理学特征、局部复发之间的相关性，以及局部复发的发生率、特征和再次手术治疗的可能性。
研究对象为2003年至2007年接受手术初始治疗后出现局部复发的51例肺癌患者。手术方式包括保守性楔形切除术、标准肺叶切除术、全肺切除术以及广泛的全肺和胸壁切除术。所有患者均接受定期随访，包括每3个月进行一次胸部CT扫描。
所有患者在根治性初次手术后中位10个月（范围1 - 30个月）被诊断为局部复发。手术类型与局部复发时间之间无统计学显著关联。病理分期为I、II和IIIa期的患者局部复发时间显著长于IIIb期和IV期患者。局部复发部位包括支气管残端、纵隔淋巴结、剩余肺实质、胸壁以及这些部位的组合。51例患者中有20例（39.27%）可行再次手术治疗。胸壁是最常见的复发部位（51例中有20例；39.2%），在接受再次手术治疗的患者组中也是最常见的（20例中有13例；65%）。鳞状细胞癌（SCC）是主要的组织学类型（51例中有38例；74.5%），其次是腺癌（51例中有9例；17.7%）。
SCC是最常见的局部复发性肺癌。初始手术方式对局部复发发生率无影响，但手术范围和彻底性有影响。局部复发时间很大程度上取决于原发肿瘤的病理分期。胸壁是最常见的复发部位，也是最适合再次手术治疗的部位，这与手术质量有关。
