Stella Franco, Luciano Giulia, Dell'Amore Andrea, Greco Domenico, Ammari Chadi, Giunta Domenica, Bini Alessandro
Thoracic Surgery Unit, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
Thoracic Surgery Unit, S.Orsola-Malpighi Hospital, University of Bologna, Italy.
Heart Lung Circ. 2016 Feb;25(2):191-5. doi: 10.1016/j.hlc.2015.07.016. Epub 2015 Aug 11.
This is an institutional review of surgical management of second pulmonary tumours in patients with history of Non-small Cell Lung Cancer (NSCLC) resection according to The American College of Chest Physicians' (ACCP) revision to the Martini and Melamed's criteria for the classification of multiple primary lung cancers (MPLC).
All patients who underwent iterative pulmonary resections for pulmonary metastasis (Group A) or MPLC (Group B) between 2006 and 2012 were reviewed and their survivals compared accordingly. The main criteria of insertion in Group B were different histology and the same histology with disease-free interval ≤ 4 years; we excluded loco-regional recurrence in nodes and/or on bronchial stump.
Group A: Twenty patients; Disease free time (DFT) after first operation was 15.2 months (range 2-44). One, two and three years overall survival after second resection was 74%, 29%, 14% respectively. Group B: Thirty-six patients. One, two and three years overall survival was 94%, 81%, and 69% respectively. No statistical differences on outcome were found between the two groups in spite of the apparent worse survival rate for Group A (p=.197).
A further resection for additional nodules, whether designated as intrapulmonary metastases or second primary NSCLC, can be an appropriate curative strategy in selected patients with unimpaired respiratory function and no evidence of distant metastatic disease. The site, the extent of the second resection, the histology and even the stage are unlikely to be related to survival.
这是一项基于美国胸科医师学会（ACCP）对马蒂尼和梅拉梅德的多原发性肺癌（MPLC）分类标准的修订，对非小细胞肺癌（NSCLC）切除术后患者的第二肺肿瘤手术管理进行的机构性回顾。
回顾了2006年至2012年间因肺转移（A组）或MPLC（B组）接受多次肺切除的所有患者，并相应比较了他们的生存率。B组纳入的主要标准是不同组织学类型以及相同组织学类型且无病间期≤4年；我们排除了淋巴结和/或支气管残端的局部区域复发。
A组：20例患者；首次手术后的无病时间（DFT）为15.2个月（范围2 - 44个月）。第二次切除术后1年、2年和3年的总生存率分别为74%、29%、14%。B组：36例患者。1年、2年和3年的总生存率分别为94%、81%和69%。尽管A组的生存率明显较差，但两组在结局上未发现统计学差异（p = 0.197）。
对于额外的结节进行进一步切除，无论其被指定为肺内转移还是第二原发性NSCLC，对于呼吸功能未受损且无远处转移疾病证据的特定患者而言，可能是一种合适的治愈策略。第二次切除的部位、范围、组织学类型甚至分期都不太可能与生存率相关。
