Yang Haitang, Sun Yifeng, Yao Feng, Yu Keke, Gu Haiyong, Han Baohui, Zhao Heng
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Department of Pathology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Ann Thorac Surg. 2016 Mar;101(3):1145-52. doi: 10.1016/j.athoracsur.2015.09.028. Epub 2015 Nov 18.
With the development of diagnostic techniques, the incidence of multiple pulmonary nodules has increased. The management of multiple primary lung cancer patients based on currently established criteria, however, remains controversial.
Patients who underwent curative operations for bilateral multiple primary lung cancer (BMPLC) based on the Martini-Melamed criterion between January 2001 and June 2014 were reviewed retrospectively.
Bilateral lobectomies and lobectomies with contralateral sublobar resections were performed in 39 and 49 patients, respectively. Bilateral sublobar resections were performed in the remaining 13 cases. Overall survival at 3 and 5 years was 84.5% and 75.0%, respectively. The use of a limited resection procedure for the contralateral second nodule in cases with stage I BMPLC did not have a negative effect on the 5-year overall survival (p = 0.752). Postoperative pathologic diagnosis classified by the most advanced TNM stage appeared to present a good correlation with prognosis in patients with BMPLC. Cox multivariate analysis identified the most advanced TNM stage (p = 0.018) and the number of lesions (p = 0.001) as significant predictors of overall survival.
The prognosis of patients after bilateral surgical treatment with curative intent for BMPLC was shown to be promising. The use of a limited resection procedure for the contralateral second nodule in cases with stage I BMPLC did not have a negative effect on the 5-year overall survival. Postoperative pathologic diagnosis classified by the most advanced TNM had a good correlation with prognosis in patients with BMPLC.
随着诊断技术的发展，多发性肺结节的发病率有所上升。然而，基于目前既定标准对多原发性肺癌患者的管理仍存在争议。
回顾性分析2001年1月至2014年6月期间根据马蒂尼 - 梅拉梅德标准接受双侧多原发性肺癌（BMPLC）根治性手术的患者。
分别对39例和49例患者进行了双侧肺叶切除术以及对侧肺叶切除术加肺叶下亚段切除术。其余13例患者进行了双侧肺叶下亚段切除术。3年和5年总生存率分别为84.5%和75.0%。对于I期BMPLC患者，对侧第二个结节采用有限切除手术对5年总生存率没有负面影响（p = 0.752）。根据最晚期TNM分期进行的术后病理诊断似乎与BMPLC患者的预后具有良好的相关性。Cox多因素分析确定最晚期TNM分期（p = 0.018）和病灶数量（p = 0.001）是总生存的重要预测因素。
对BMPLC患者进行双侧根治性手术治疗后的预后显示良好。对于I期BMPLC患者，对侧第二个结节采用有限切除手术对5年总生存率没有负面影响。根据最晚期TNM进行的术后病理诊断与BMPLC患者的预后具有良好的相关性。
