Hattori Aritoshi, Matsunaga Takeshi, Takamochi Kazuya, Oh Shiaki, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.
Thorac Cardiovasc Surg. 2017 Mar;65(2):142-149. doi: 10.1055/s-0036-1572437. Epub 2016 Feb 22.
We evaluated the clinicopathologic characteristics and oncologic outcome in patients who underwent surgical resection for multifocal ground-glass opacities (GGOs) of the lung. We examined 131 patients who underwent surgical resections for multiple clinical-N0 lung cancers. Multifocal GGOs were defined as tumors showing GGO dominance with a consolidation/tumor ratio (CTR) < 0.5 for all, whereas solid lesions were defined as having at least one tumor that showed CTR ≥0.5. Multifocal GGOs were found in 53 (40.5%) patients. A significantly large number of GGOs with a median of 3 per patient (range 2-41) was observed in multifocal GGOs ( < 0.0001). A multivariate analysis demonstrated tumor size ≤ 20 mm ( = 0.0407) and multifocal GGOs ( = 0.0345) were significantly associated with the survival. Regarding surgical managements for multifocal GGOs, the 5-year overall survival (OS) of multiple synchronous or staged limited resection only ( = 26) versus anatomical resection with or without additional limited resection ( = 27) was not significantly different (100% and 91.9%, = 0.2287). The total number of resected multifocal GGOs was 278, most of which revealed adenocarcinoma or precancerous lesions. Unresected or new GGOs developed in 19 (35.8%) patients, all of which remained pure-GGO of < 10 mm in size without any interventions. The 5-year OS of multifocal GGOs and solid lesions were 94.4% and 80.6% ( = 0.0096), with a median follow-up time of 60 months. Surgical interventions combined with limited surgery or adequate follow-up management based on the findings on thin-section CT could provide acceptable oncologic outcomes for multifocal GGOs.
我们评估了接受手术切除肺部多灶性磨玻璃影(GGO)患者的临床病理特征和肿瘤学结局。我们研究了131例接受多灶性临床N0期肺癌手术切除的患者。多灶性GGO定义为所有肿瘤均以GGO为主且实性成分/肿瘤比例(CTR)<0.5,而实性病变定义为至少有一个肿瘤的CTR≥0.5。53例(40.5%)患者发现有多灶性GGO。在多灶性GGO中观察到GGO数量显著较多,每位患者的中位数为3个(范围2 - 41个)(<0.0001)。多因素分析表明肿瘤大小≤20 mm(=0.0407)和多灶性GGO(=0.0345)与生存率显著相关。关于多灶性GGO的手术管理,单纯多灶性同步或分期有限切除(=26)与解剖性切除联合或不联合额外有限切除(=27)的5年总生存率(OS)无显著差异(分别为100%和91.9%,=0.2287)。切除的多灶性GGO总数为278个,其中大多数为腺癌或癌前病变。19例(35.8%)患者出现未切除或新的GGO,所有这些GGO均为大小<10 mm的纯GGO,无需任何干预。多灶性GGO和实性病变的5年OS分别为94.4%和80.6%(=0.0096),中位随访时间为60个月。基于薄层CT检查结果,手术干预联合有限手术或充分的随访管理可为多灶性GGO提供可接受的肿瘤学结局。