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肺部多灶性磨玻璃影的外科治疗:临床病理与影像学表现的相关性

Surgical Management of Multifocal Ground-Glass Opacities of the Lung: Correlation of Clinicopathologic and Radiologic Findings.

作者信息

Hattori Aritoshi, Matsunaga Takeshi, Takamochi Kazuya, Oh Shiaki, Suzuki Kenji

机构信息

Department of General Thoracic Surgery, Juntendo University, Tokyo, Japan.

出版信息

Thorac Cardiovasc Surg. 2017 Mar;65(2):142-149. doi: 10.1055/s-0036-1572437. Epub 2016 Feb 22.

Abstract

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.

摘要

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。

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