Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Lung Cancer. 2017 Nov;113:7-13. doi: 10.1016/j.lungcan.2017.09.001. Epub 2017 Sep 7.
Revised TNM classification has proposed a new clinical classification of lung cancers with multiple pulmonary sites. However, definition of the radiological findings and their prognostic impacts are still controversial. Therefore, we evaluated the prognostic impact of multiple lung cancers based on the radiologic classifications concluded from findings on thin-section computed tomography.
Among surgically resected 1440 c-stage I lung cancer patients, 246 (17.1%) with multiple lung tumors were reviewed. All tumors were classified into 3 groups based on the extent of ground glass opacity (GGO), i.e., consolidation tumor ratio (CTR); GGO-dominant (GD; 0≤CTR<0.5), solid-dominant (SD; 0.5≤CTR<1.0) and pure-solid (PS; CTR=1.0). Multiple lung tumors were divided radiologically into 6 groups, and their prognoses were compared with that of c-stage I lung cancer using Cox's proportional hazard model.
Of all, 198 patients (80.5%) were surgically resected more than two tumors and determined as multiple lung cancers pathologically. The number of patients with GD+GD=73 (30%), GD+SD=54 (22%), GD+PS=53 (21%), SD+SD=12 (5%), SD+PS=20 (8%) and PS+PS=34 (14%). A multivariate analysis revealed that PS+PS group consisted of independently significant prognosticator (p<0.001). The overall survival (OS) was 97.3% in GD+GD, 98.2% in GD+SD, 84.8% in GD+PS, 90.9% in SD+SD, 78.7% in SD+PS and 41.8% in PS+PS groups, showing a significant difference between PS+PS group and the other groups. Furthermore, the OS of 1194 c-stage I lung cancer patients was 78.2%, and the prognosis of PS+PS group was significantly poor compared with that of c-stage I (p<0.001), while OS of the other groups were almost equivalent or much better than the c-stage I.
Among multiple lung cancers, PS+PS group is associated with poor survival, which would contribute to the upstaging of T descriptors. The presence of GGO is extremely important when considering the correlation between radiological classification of multiple lung cancers and its prognosis.
修订后的 TNM 分类提出了一种新的多部位肺癌临床分类。然而，关于影像学表现及其预后影响的定义仍存在争议。因此，我们根据薄层 CT 检查结果评估了多部位肺癌的预后影响。
在接受手术切除的 1440 例 c 期 I 肺癌患者中，回顾性分析了 246 例（17.1%）多肺肿瘤患者。所有肿瘤均根据磨玻璃密度（GGO）的范围分为 3 组，即实变肿瘤比（CTR）；GGO 为主型（GD；0≤CTR<0.5）、实性为主型（SD；0.5≤CTR<1.0）和纯实性型（PS；CTR=1.0）。多肺肿瘤在影像学上分为 6 组，并用 Cox 比例风险模型与 c 期 I 肺癌的预后进行比较。
所有患者中，198 例（80.5%）接受了两次以上的多肿瘤切除术，并通过病理检查确定为多肺肿瘤。GD+GD 型 73 例（30%）、GD+SD 型 54 例（22%）、GD+PS 型 53 例（21%）、SD+SD 型 12 例（5%）、SD+PS 型 20 例（8%）和 PS+PS 型 34 例（14%）。多变量分析显示 PS+PS 组是独立的预后预测因子（p<0.001）。GD+GD 组的总生存率（OS）为 97.3%，GD+SD 组为 98.2%，GD+PS 组为 84.8%，SD+SD 组为 90.9%，SD+PS 组为 78.7%，PS+PS 组为 41.8%，PS+PS 组与其他组之间存在显著差异。此外，1194 例 c 期 I 肺癌患者的 OS 为 78.2%，PS+PS 组的预后明显差于 c 期 I（p<0.001），而其他组的 OS 几乎与 c 期 I 相当或更好。
在多部位肺癌中，PS+PS 组与生存不良相关，这将有助于 T 期的升级。当考虑多部位肺癌的影像学分类及其预后之间的相关性时，GGO 的存在非常重要。
