Nakajima Takahiro, Cypel Marcelo, de Perrot Marc, Pierre Andrew, Waddell Tom, Singer Lianne, Roberts Heidi, Keshavjee Shaf, Yasufuku Kazuhiro
Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Interventional Thoracic Surgery Program, Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Semin Thorac Cardiovasc Surg. 2015 Spring;27(1):9-14. doi: 10.1053/j.semtcvs.2015.02.006. Epub 2015 Mar 7.
Unexpected lung cancer is sometimes found in explanted lungs. The objective of this study was to review these patients and their outcomes to better understand and optimize management protocols for lung transplant candidates with pulmonary nodules. Retrospective analysis of pretransplant imaging and clinicopathologic characteristics of patients who were found to have lung cancer in their explanted lungs was performed. From January 2003 to December 2012, 13 of 853 lung transplant recipients were found to have unexpected lung cancer in their explanted lung (1.52%). Of them, 9 cases were for interstitial lung disease (2.8%; 9/321 recipients) and 4 cases were for chronic obstructive pulmonary disease (1.57%; 4/255 recipients). The median period between computed tomographic scan and lung transplantation was 2.40 months (range: 0.5-19.2). On computed tomographic scan, only 3 cases were shown to possibly have a neoplasm by the radiologist. The staging of these lung cancers was as follows: 3 cases of IA, 1 case of IB, 5 cases of IIA, 1 case of IIIA, and 3 cases of IV. Of 13 cases, 9 died owing to cancer progression. On the contrary, only 1 stage I case with small cell lung cancer showed cancer recurrence. The median survival time was 339 days, and the 3-year survival rate was 11.0%. In conclusion, most of the patients with unexpected lung cancer showed poor prognosis except for the early-stage disease. The establishment of proper protocol for management of such nodules is important to improve the management of candidates who are found to have pulmonary nodules on imaging.
意外性肺癌有时会在切除的肺中被发现。本研究的目的是回顾这些患者及其预后情况，以便更好地理解并优化针对有肺结节的肺移植受者的管理方案。对在切除的肺中发现患有肺癌的患者的移植前影像学和临床病理特征进行了回顾性分析。2003年1月至2012年12月期间，853例肺移植受者中有13例（1.52%）在其切除的肺中发现意外性肺癌。其中，9例为间质性肺疾病（2.8%；9/321例受者），4例为慢性阻塞性肺疾病（1.57%；4/255例受者）。计算机断层扫描与肺移植之间的中位时间为2.40个月（范围：0.5 - 19.2个月）。在计算机断层扫描中，放射科医生仅发现3例可能患有肿瘤。这些肺癌的分期如下：IA期3例，IB期1例，IIA期5例，IIIA期1例，IV期3例。13例患者中，9例因癌症进展死亡。相反，仅1例I期小细胞肺癌患者出现癌症复发。中位生存时间为339天，3年生存率为11.0%。总之，除早期疾病外，大多数意外性肺癌患者预后较差。建立针对此类结节的恰当管理方案对于改善在影像学检查中发现有肺结节的受者的管理非常重要。
