Shimada Yoshihisa, Saji Hisashi, Otani Keishi, Maehara Sachio, Maeda Junichi, Yoshida Koichi, Kato Yasufumi, Hagiwara Masaru, Kakihana Masatoshi, Kajiwara Naohiro, Ohira Tatsuo, Akata Soichi, Ikeda Norihiko
First Department of Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
Department of Chest Surgery, St. Marianna University School of Medicine, Yokohama, Japan.
Lung Cancer. 2015 May;88(2):174-80. doi: 10.1016/j.lungcan.2015.02.016. Epub 2015 Mar 1.
We reviewed the medical record of a series of patients with synchronous multiple lung cancers (SMLC), in an attempt to identify the optimal treatment strategy for multiple ground-glass opacities (GGOs).
From 2004 to 2010, 1223 patients underwent complete resection of non-small cell lung cancer. Among these, there were 67 patients (5.5%) with SMLC with at least 1 of the nodules showing GGO appearance. SMLC was divided into the main cancer (MC) which was a main target based on its tumor size or radiological invasiveness and sub-nodules. According to consolidation/tumor ratio (CTR) on thin-section computed tomography, 67 cases were classified into GG-group (MC showing GGO-dominant lesion; CTR≤0.5) and GS-group (MC showing solid-dominant lesion; CTR>0.5).
There were 24 patients in the GG-group (36%) and 43 patients in the GS-group (64%). Surgical resections included 11 sublobar resections (SLs), 32 lobectomies, 19 lobectomy+SLs, and 4 bilobectomies. There were 39 patients with a total of 118 unresected GGOs after the initial surgery. Among them, the frequency of growth was 8% on a per-nodule basis with the median tumor doubling time of 1373 days, and new GGOs emerged in 15 patients (23%). Multivariate analysis demonstrated that larger size of MC and the GS-group was associated with poor prognosis, whereas growth of the residual GGOs, the development of new GGOs, or whether or not all GGOs were treated did not affect survival. The 5-year OS proportions were 95.8% for the GG-group and 68.0% for the GS-group (p=0.009), and 92.4% for a MC of ≤25 mm and 53.6% for a MC of >25 mm (p=0.008).
Survival of patients with multifocal GGOs is strongly affected by radiological findings of the MC. Strict surgical control for MC could be most important.
我们回顾了一系列同步性多原发性肺癌（SMLC）患者的病历，试图确定针对多个磨玻璃影（GGO）的最佳治疗策略。
2004年至2010年，1223例患者接受了非小细胞肺癌的根治性切除术。其中，67例（5.5%）为SMLC，至少有1个结节表现为GGO形态。SMLC分为基于肿瘤大小或影像学侵袭性的主要癌灶（MC）和子结节。根据薄层计算机断层扫描上的实性成分/肿瘤比率（CTR），67例患者被分为GG组（MC表现为以GGO为主的病变；CTR≤0.5）和GS组（MC表现为以实性为主的病变；CTR>0.5）。
GG组有24例患者（36%），GS组有43例患者（64%）。手术切除包括11例亚肺叶切除（SL）、32例肺叶切除、19例肺叶切除+SL以及4例双肺叶切除。初次手术后有39例患者共118个未切除的GGO。其中，每个结节的生长频率为8%，肿瘤倍增时间中位数为1373天，15例患者（23%）出现了新的GGO。多因素分析表明，MC较大和GS组与预后不良相关，而残留GGO的生长、新GGO的出现或所有GGO是否得到治疗均不影响生存。GG组的5年总生存率为95.8%，GS组为68.0%（p=0.009），MC≤25mm的患者为92.4%，MC>25mm的患者为53.6%（p=0.008）。
多灶性GGO患者的生存受MC影像学表现的强烈影响。对MC进行严格的手术控制可能最为重要。
