Verhagen A F, van de Wal H J, Cox A L, Lacquet L K
Department of Thoracic and Cardiac Surgery, University Hospital Sint-Radboud, Nijmegen, Netherlands.
Thorac Cardiovasc Surg. 1989 Apr;37(2):107-11. doi: 10.1055/s-2007-1013919.
Multiple primary lung cancers are now being recognized more frequently. Out of 1004 patients with a resected lung cancer, 32 (3.2%) presented a second primary and two of them a third primary lung cancer. A synchronous (S) primary was present in 7 and a metachronous (M) primary was present in 25. The histology was different in 1/7 with a S. and in 6/25 with a M. cancer. In all cases the cancer was located in another segment, lobe or lung. Out of the 7 with a S. cancer, 3 had a one stage and 4 a staged resection; out of the 25 with a M. cancer, 3 were treated by chemotherapy, 22 had a 2nd and 1 a 3rd operation to remove a new cancer. The mean time interval in M. cancer was 4 years, 8 months and was longer for adeno- (8 years) than for squamous cell carcinomas (4 years), longer for a contralateral cancer (6 years, 7 months) and longer for mild smokers (5 years, 1 month). The early mortality (10.3%) was 0/7 for S. and 3/22 for M. cancers. The three and five years actuarial survival of operated patients was 67% and 25% for S. and 43% and 31% for M. cancers. Survival is positively affected by a resection interval of more than 3 years and by 3 instead of 2 remaining lobes after the second resection. In conclusion a close follow-up of operated lung cancer patients is necessary and aggressive surgical approach is indicated for a new primary cancer.
现在，多原发性肺癌的确诊更为常见。在1004例接受肺癌切除术的患者中，32例（3.2%）出现了第二原发性肺癌，其中2例出现了第三原发性肺癌。7例为同时性（S）原发性肺癌，25例为异时性（M）原发性肺癌。7例S期肺癌中有1例组织学不同，25例M期肺癌中有6例组织学不同。所有病例中，癌症均位于另一个肺段、肺叶或另一侧肺。7例S期癌症患者中，3例接受了一期切除，4例接受了分期切除；25例M期癌症患者中，3例接受了化疗，22例接受了第二次手术，1例接受了第三次手术以切除新的癌症。M期癌症的平均时间间隔为4年8个月，腺癌（8年）比鳞状细胞癌（4年）更长，对侧癌症（6年7个月）更长，轻度吸烟者（5年1个月）更长。早期死亡率S期为0/7，M期为3/22。手术患者的三年和五年精算生存率S期分别为67%和25%，M期分别为43%和31%。切除间隔超过3年以及第二次切除后保留3个而非2个肺叶对生存率有积极影响。总之，对接受手术的肺癌患者进行密切随访是必要的，对于新的原发性癌症应采取积极的手术方法。
