Thoracic Surgery Unit, University of Eastern Piedmont, Via Frasconi, 14, I-28100 Novara, Italy.
Eur J Surg Oncol. 2013 Nov;39(11):1248-53. doi: 10.1016/j.ejso.2013.08.014. Epub 2013 Aug 24.
The present study was carried out to evaluate the characteristics of solitary pulmonary nodule (SPN) in patients with previous cancer(s) and to analyse the outcome of its surgical treatment.
We retrospectively analysed 131 patients with history of previous malignancy submitted to lung surgery for new identified SPN between January 2004 and December 2009.
The diagnosis was metastasis in 65 patients, primary lung cancer in 57, benign lesion in 9. Primary lung cancers were significantly larger, had higher maxSUV at CT-PET scanning, occurred after a longer disease-free interval in patients older and with worse lung function when compared with metastatic lesions. Overall survival at 5-year was 67% for benign lesions, 62% for primary lung cancer, 48% for metastatic disease. Histological subtype, SPN diameter less than 2 cm and DFI >36 months were factors influencing long-term prognosis of metastatic patients. Histological subtype and pathological staging were factors influencing long-term outcome of primary lung cancer patients.
Surgical resection of solitary pulmonary nodule is essential in patients with history of previous cancer to rule out benign lesions, to offer diagnostic confirmation and local control of the disease in metastatic tumours and to correctly stage and treat primary lung cancer.
本研究旨在评估既往癌症患者孤立性肺结节（SPN）的特征，并分析其手术治疗的结果。
我们回顾性分析了 2004 年 1 月至 2009 年 12 月期间因新发现的 SPN 而接受肺手术的 131 例有既往恶性肿瘤病史的患者。
65 例诊断为转移瘤，57 例为原发性肺癌，9 例为良性病变。与转移性病变相比，原发性肺癌的肿瘤明显更大，CT-PET 扫描时最大 SUV 值更高，无病间期更长，且发生在年龄较大和肺功能较差的患者中。良性病变的 5 年总生存率为 67%，原发性肺癌为 62%，转移性疾病为 48%。组织学亚型、SPN 直径<2cm 和 DFI>36 个月是影响转移性患者长期预后的因素。组织学亚型和病理分期是影响原发性肺癌患者长期预后的因素。
对于有既往癌症病史的患者，手术切除孤立性肺结节对于排除良性病变、提供诊断证实以及控制转移性肿瘤的疾病局部进展非常重要，并且可以正确分期和治疗原发性肺癌。
