Koike Terumoto, Goto Tatsuya, Kitahara Akihiko, Sato Seijiro, Saitoh Masayuki, Hashimoto Takehisa, Namura Osamu, Takahashi Masashi, Toyabe Shin-Ichi, Tsuchida Masanori
Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan.
Department of Chest Surgery, Niigata Prefectural Central Hospital, 205 Shinnan-cho, Joetsu, Niigata, Japan.
Surg Today. 2017 Dec;47(12):1469-1475. doi: 10.1007/s00595-017-1537-3. Epub 2017 May 4.
To establish the most effective methods of postoperative surveillance to detect early recurrence of lung adenocarcinoma.
The subjects of this retrospective study were 485 patients with p-stage I-III lung adenocarcinoma, who underwent postoperative surveillance. We examined the sites and detection modes of recurrence and calculated the recurrence-free probabilities. Patients with stage I disease were divided into low- and high-risk recurrence groups using a risk score calculated by assigning points proportional to risk factor regression coefficients.
Of the 112 patients with recurrence, 86 had intrathoracic recurrence. Routine computed tomography (CT) revealed recurrence in 60 patients. The recurrence-free probability curves showed that 95% of recurrences were identified within the first 4 years after resection in patients with stage II/III disease. In patients with stage I disease, the predictors of recurrence included male sex, positive pleural lavage cytology, moderate-to-poor differentiation, and visceral pleural invasion. Postoperative recurrences were detected throughout the follow-up period in the high-risk group.
Routine chest CT plays an important role in the postoperative surveillance of lung adenocarcinoma. We recommend intensive follow-up during the early post-resection period for patients with advanced stage disease and long-term follow-up for high-risk patients with stage I disease.
建立检测肺腺癌早期复发的最有效术后监测方法。
本回顾性研究的对象为485例接受术后监测的Ⅰ - Ⅲ期肺腺癌患者。我们检查了复发部位和检测方式，并计算了无复发生存概率。对于Ⅰ期疾病患者，使用根据与危险因素回归系数成比例分配分数计算出的风险评分，将其分为低风险和高风险复发组。
在112例复发患者中，86例有胸内复发。常规计算机断层扫描（CT）发现60例复发。无复发生存概率曲线显示，Ⅱ/Ⅲ期疾病患者中95%的复发在切除后的前4年内被发现。在Ⅰ期疾病患者中，复发的预测因素包括男性、胸膜灌洗细胞学阳性、中 - 低分化和脏层胸膜侵犯。高风险组在整个随访期均检测到术后复发。
常规胸部CT在肺腺癌术后监测中起重要作用。我们建议对晚期疾病患者在术后早期进行强化随访，对Ⅰ期疾病的高风险患者进行长期随访。
