Muranishi Yusuke, Sonobe Makoto, Hamaji Masatsugu, Kawaguchi Atsushi, Hijiya Kyoko, Motoyama Hideki, Menju Toshi, Aoyama Akihiro, Chen-Yoshikawa Toyofumi F, Sato Toshihiko, Date Hiroshi
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University.
Interact Cardiovasc Thorac Surg. 2018 Apr 1;26(4):631-637. doi: 10.1093/icvts/ivx389.
Surgical treatments for metachronous second primary lung cancer (MSPLC) may be increasing. It was thought that surgery for MSPLC is associated with high mortality and morbidity. However, recent diffusion of minimally invasive surgical procedures may improve the safety of surgery for MSPLC. The aim of this study was to clarify the safety and prognosis of surgery for MSPLC compared with that for primary lung cancer (PLC).
We reviewed medical records of 1340 patients who underwent pulmonary resection for non-small-cell lung cancer between 2006 and 2013. We identified patients with PLC and those with MSPLC, and surgical parameters and survival outcome were compared. To eliminate selection bias between the MSPLC group and the PLC group, propensity score-matched analysis on the basis of clinicopathological factors was performed.
Fifty-three patients underwent resection for MSPLC. Propensity score matching identified 50 patients from each treatment group. Of the 50 MSPLC patients, 41 (82.0%) underwent segmentectomy or wedge resection, 44 (82.0%) had clinical Stage I tumour and 36 (72.0%) received resection via video-assisted thoracoscopic surgery approach. Postoperative complications with a severity of Grade II or more occurred in 11 (22.0%) patients. The incidence of postoperative complications in the MSPLC group was not different from that of the PLC group (P = 0.4894). The 5-year overall survival rates were 68.7% and 83.0% in the PLC and the MSPLC groups, respectively. There was no significant difference between the PLC and the MSPLC groups in terms of overall survival (P = 0.2018, log-rank test).
Pulmonary resection for MSPLC was safely performed with low short-term morbidity similar to that of PLC, and its long-term overall survival was acceptable.
异时性第二原发性肺癌（MSPLC）的外科治疗可能在增加。过去认为MSPLC手术与高死亡率和高发病率相关。然而，近期微创外科手术的普及可能会提高MSPLC手术的安全性。本研究的目的是阐明MSPLC手术与原发性肺癌（PLC）手术相比的安全性和预后。
我们回顾了2006年至2013年间1340例行非小细胞肺癌肺切除术患者的病历。我们确定了PLC患者和MSPLC患者，并比较了手术参数和生存结果。为消除MSPLC组和PLC组之间的选择偏倚，基于临床病理因素进行了倾向评分匹配分析。
53例患者接受了MSPLC切除术。倾向评分匹配后每个治疗组各有50例患者。50例MSPLC患者中，41例（82.0%）接受了肺段切除术或楔形切除术，44例（82.0%）为临床I期肿瘤，36例（72.0%）通过电视辅助胸腔镜手术入路进行了切除。11例（22.0%）患者发生了严重程度为II级或更高的术后并发症。MSPLC组术后并发症发生率与PLC组无差异（P = 0.4894）。PLC组和MSPLC组的5年总生存率分别为68.7%和83.0%。PLC组和MSPLC组在总生存方面无显著差异（P = 0.2018，对数秩检验）。
MSPLC肺切除术安全实施，短期发病率低，与PLC相似，其长期总生存可接受。
