Huang Yen-Hsiang, Hsu Kuo-Hsuan, Tseng Jeng-Sen, Chen Kun-Chieh, Su Kang-Yi, Chen Hsuan-Yu, Chang Chi-Sheng, Chen Jeremy J W, Yu Sung-Liang, Chen Huei-Wen, Yang Tsung-Ying, Chang Gee-Chen
1 Division of Chest Medicine, 2 Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ; 3 Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ; 4 Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan ; 6 Institute of Statistical Science, Academia Sinica, Taipei, Taiwan ; 7 NTU Center for Genomic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan ; 8 Department of Pathology and Graduate Institute of Pathology, 9 Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei, Taiwan ; 10 Graduate Institute of Toxicology, National Taiwan University, Taipei, Taiwan ; 11 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ; 12 Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan.
J Thorac Dis. 2016 Jan;8(1):86-92. doi: 10.3978/j.issn.2072-1439.2016.01.24.
Lung cancer with lung to lung metastasis is common. The objective of this study was to investigate the association among the distribution of contralateral lung metastases versus primary lung tumor location, clinical characteristics, and epidermal growth factor receptor (EGFR) mutations status.
The study included treatment-naïve stage IV lung adenocarcinoma with contralateral lung metastases from 2012 through 2013.
In total, 103 patients were enrolled after excluding lung cancer with histology other than adenocarcinoma, synchronous multiple primary lung cancers, or other active malignancy. The median age was 65 years (range, 28-93 years); 47 male patients (45.6%); 69 non-smoker (NS) patients (67.0%); 68 Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 patients (66.0%); 38 M1a patients (38.9%); and 60 EGFR mutation patients (58.3%). There were 51 cases (49.5%) with primary lung cancer located over upper lobes. Among them, 36 (70.6%) had contralateral upper lung predominance metastasis, 9 (17.6%) had lower lung predominance, and 6 (11.8%) had equal distribution. Among the 52 lower lobe tumors, 17 (32.7%), 19 (36.5%), and 16 (30.8%) had upper, lower lung predominance, and equal distribution metastasis, respectively. Univariate analysis showed only male gender and primary tumor location over upper lobes were significantly associated with contralateral upper lung predominance metastases. After multivariate analysis, only primary tumor location over upper lobes was significantly associated with contralateral upper lung predominance metastases (adjusted OR 5.49, 95% CI, 2.15-14.03, P<0.001).
Upper lobe lung adenocarcinoma was significantly associated with contralateral upper lung predominance metastases. Further research is needed to elucidate the mechanisms underlying this phenomenon.
肺癌肺内转移很常见。本研究的目的是探讨对侧肺转移的分布与原发性肺癌位置、临床特征及表皮生长因子受体（EGFR）突变状态之间的关联。
本研究纳入了2012年至2013年未经治疗的伴有对侧肺转移的IV期肺腺癌患者。
排除组织学类型非腺癌的肺癌、同步性多原发性肺癌或其他活动性恶性肿瘤后，共纳入103例患者。中位年龄为65岁（范围28 - 93岁）；男性患者47例（45.6%）；非吸烟（NS）患者69例（67.0%）；东部肿瘤协作组（ECOG）体能状态（PS）为0 - 1的患者68例（66.0%）；M1a期患者38例（38.9%）；EGFR突变患者60例（58.3%）。原发性肺癌位于上叶的有51例（49.5%）。其中，36例（70.6%）对侧肺转移以上肺为主，9例（17.6%）以下肺为主，6例（11.8%）分布均等。在52例下叶肿瘤中，分别有17例（32.7%）、19例（36.5%）和16例（30.8%）出现上肺为主、下肺为主及分布均等的转移。单因素分析显示，仅男性性别和原发性肿瘤位于上叶与对侧上肺为主的转移显著相关。多因素分析后，仅原发性肿瘤位于上叶与对侧上肺为主的转移显著相关（校正比值比5.49，95%可信区间2.15 - 14.03，P <0.001）。
上叶肺腺癌与对侧上肺为主的转移显著相关。需要进一步研究以阐明这一现象的潜在机制。
