Xiao Fei, Liu Deruo, Guo Yongqing, Shi Bin, Song Zhiyi, Tian Yanchu, Zhang Zhenrong, Liang Chaoyang
Department of Thoracic Surgery, National Clinical Research Center for Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
J Thorac Dis. 2017 Apr;9(4):990-1001. doi: 10.21037/jtd.2017.03.59.
The diagnosis, staging, and therapeutic strategy for synchronous multiple primary non-small cell lung cancer (SMP-NSCLC) remain unclear. Distinguishing SMP-NSCLC from intrapulmonary metastasis is difficult but of great importance for selecting the surgical procedure and prognoses.
Fifty-two patients diagnosed with SMP-NSCLC according to the modified Martini-Melamed criteria in the thoracic surgery department of the China-Japan Friendship Hospital from November 2004 to December 2015 were enrolled in this retrospective study. A total of 106 tumors were subjected to pathological examination. Close follow-up and survival analysis were performed.
The perioperative morbidity rate was 5.8%, with no cases of perioperative death. The overall 5-year survival rate was 40.6%, the cancer-specific 5-year survival rate was 54.5%, and the median survival time was 52 months. Older age (P=0.553), sex (P=0.600), smoking history (P=0.496), tumor distribution (P=0.461), video-assisted thoracoscopic surgery (VATS) (P=0.398), and adjuvant chemotherapy (P=0.078) did not affect survival. Preoperative percentage of forced expiratory volume in the first second (P=0.022), Charlson comorbidity index (P=0.034), surgical procedure (P=0.040), and highest pT stage (P=0.022) were independent risk factors in the multivariate analysis. Different pathological subtypes were identified in 13 of 18 cases of multiple adenocarcinomas. Different gene mutation types and correlations between tumors were identified through NGS in those with the same pathological subtype.
Postoperative survival rates in SMP-NSCLC were satisfactory. Non-radical resection might improve the prognosis for patients with a tolerable general condition and pulmonary function. Higher pT stage might result in poorer survival rates. Larger sample size and future study are still needed to identify the prognostic factors. Comprehensive histologic assessment and next generation sequencing (NGS) could be effective methods for screening SMP-NSCLC.
同步性多原发性非小细胞肺癌（SMP - NSCLC）的诊断、分期及治疗策略仍不明确。区分SMP - NSCLC与肺内转移困难，但对于选择手术方式及判断预后至关重要。
选取2004年11月至2015年12月在中国医学科学院肿瘤医院胸外科根据改良的Martini - Melamed标准诊断为SMP - NSCLC的52例患者纳入本回顾性研究。共106个肿瘤接受了病理检查。进行了密切随访及生存分析。
围手术期发病率为5.8%，无围手术期死亡病例。5年总生存率为40.6%，癌症特异性5年生存率为54.5%，中位生存时间为52个月。年龄较大（P = 0.553）、性别（P = 0.600）、吸烟史（P = 0.496）、肿瘤分布（P = 0.461）、电视辅助胸腔镜手术（VATS）（P = 0.398）及辅助化疗（P = 0.078）均不影响生存。多因素分析中，第1秒用力呼气量术前百分比（P = 0.022）、Charlson合并症指数（P = 0.034）、手术方式（P = 0.040）及最高pT分期（P = 0.022）为独立危险因素。18例多原发性腺癌中有13例存在不同病理亚型。通过二代测序（NGS）在相同病理亚型患者中鉴定出不同基因突变类型及肿瘤间的相关性。
SMP - NSCLC术后生存率令人满意。对于一般状况和肺功能可耐受的患者，非根治性切除可能改善预后。较高的pT分期可能导致较差的生存率。仍需要更大样本量及进一步研究以确定预后因素。综合组织学评估及二代测序（NGS）可能是筛查SMP - NSCLC的有效方法。
