Peng Yue, Ren Wangang, Wang Hui, Li Meng, Feng Zhen, Peng Zhongmin
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, P. R. China.
J Cancer Res Ther. 2017;13(4):702-706. doi: 10.4103/jcrt.JCRT_140_17.
The detection rate of synchronous multiple primary lung cancers (SMPLC) showed an increasing trend year by year. In an attempt to identify the optimal treatment strategy for SMPLC, we retrospectively analyzed our surgical treatment outcomes of a series of patients with SMPLC.
A total of 43 SMPLC patients who met the modified Martini-Melamed criteria and with clinical data retained between November 2012 and July 2016 underwent complete resection without any preoperative induction therapy at the Department of Thoracic Surgery, Shandong Provincial Hospital. The relationships between gender, age, family history of cancer, the number of tumors, the location of tumors, tumor size, tumor histology, regional lymph node metastasis, type of surgery, pathological stage, epidermal growth factor receptor (EGFR) mutation, mortality, and survival were further analyzed.
Among the 43 patients, 29 (67.4%) patients had ipsilateral tumors, whereas 14 (32.6%) patients had contralateral tumors. Nine patients with contralateral tumors underwent one-stage surgical treatment, with mean postoperative hospitalization days of 9.8. EGFR mutations were detected in 5 patients with synchronous multiple primary lung adenocarcinomas (SMPLA) for each lesion independently. The results showed different tumors in the same patient could carry different EGFR mutations. The 1- and 3-year overall survival (OS) rates were 97.0% and 76.7%, respectively. Larger maximal tumor dimension (P = 0.015), advanced pN stage (P = 0.002), advanced pT stage (P = 0.046), advanced TNM stage (P = 0.013), and postoperative adjuvant chemotherapy (P = 0.025) were correlated with poor OS.
SMPLC could be considered to be a local disease rather than the systemic disease. Surgical treatment is an effective approach for patients with SMPLC. Mutational status of EGFR could be used as a diagnostic criterion, especially in patients with SMPLA.
同步性多原发性肺癌（SMPLC）的检出率呈逐年上升趋势。为确定SMPLC的最佳治疗策略，我们回顾性分析了一系列SMPLC患者的手术治疗结果。
2012年11月至2016年7月期间，山东省立医院胸外科共有43例符合改良马蒂尼 - 梅拉梅德标准且保留临床资料的SMPLC患者，在未进行任何术前诱导治疗的情况下接受了根治性切除。进一步分析了性别、年龄、癌症家族史、肿瘤数量、肿瘤位置、肿瘤大小、肿瘤组织学、区域淋巴结转移、手术类型、病理分期、表皮生长因子受体（EGFR）突变、死亡率和生存率之间的关系。
43例患者中，29例（67.4%）患者肿瘤位于同侧，而14例（32.6%）患者肿瘤位于对侧。9例对侧肿瘤患者接受了一期手术治疗，术后平均住院天数为9.8天。5例同步性多原发性肺腺癌（SMPLA）患者的每个病灶均独立检测到EGFR突变。结果显示，同一患者的不同肿瘤可能携带不同的EGFR突变。1年和3年总生存率（OS）分别为97.0%和76.7%。最大肿瘤直径较大（P = 0.015）、pN分期较晚（P = 0.002）、pT分期较晚（P = 0.046）、TNM分期较晚（P = 0.013）以及术后辅助化疗（P = 0.025）与OS较差相关。
SMPLC可被视为一种局部疾病而非全身性疾病。手术治疗是SMPLC患者的有效治疗方法。EGFR的突变状态可作为诊断标准，尤其是在SMPLA患者中。
