Li Jingxu, Yang Xinguan, Xia Tingting, Guan Yubao, Zhong Nanshan
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
J Thorac Dis. 2017 Dec;9(12):5335-5344. doi: 10.21037/jtd.2017.12.101.
Studies have reported that up to 8% of non-small cell lung cancers (NSCLC) involve multiple lesions; no detailed study has assessed the prognosis of early synchronous multiple primary non-small cell lung cancer (SMPNSCLC) (T1N0M0, T2aN0M0). We aimed to assess the spiral CT manifestations of SMPNSCLC during stage I and evaluate the effect of TNM staging with the 7th and 8th editions on the prognosis.
We retrospectively analyzed the data of patients who were examined, operated, and pathologically confirmed as having NSCLC from January 1, 2009, to December 31, 2010, and were followed-up for 5 years. The number of cases with stage I SMPNSCLC and solitary primary NSCLC (SPNSCLC) was 36 and 133 as per the 7th edition TNM staging system and 34 and 111 as per the 8th edition TNM staging system, respectively. The relationship between sex, age, smoking history, emphysema, surgical procedure, pathological type, tumor location, and tumor size was evaluated between the two groups, along with the correlation between prognosis and TNM staging with the 7th and 8th editions.
A total of 1,948 cases of NSCLC underwent surgery, including 36 cases of stage I SMPNSCLC (77 lesions; 1.85%) with an age of onset of 44-86 years (median age, 60 years). The tumors primarily included adenocarcinoma (93.5%), with a diameter of 0.4-4.5 cm (median, 2.3 cm). CT indicated round/oval tumors in 81.8% cases, lobulation in 79.2% cases, spiculation sign in 70.1% cases, bronchial truncation sign in 31.2% cases, and pleural indentation in 75.3% cases. Moreover, CT indicated the presence of 36 (46.8%) solid nodules and 41 (53.2%) sub-solid nodules. With the 7th edition TNM staging system, the 5-year overall survival (OS) and disease-free survival (DFS) rates for stage ISMPNSCLC were 86.1% and 72.2%, respectively, which did not significantly differ from the prognosis of 133 cases of stage I SPNSCLC (P=0.587, P=0.273). With the 8th edition TNM staging system, the 5-year OS and DFS rates for stage I SMPNSCLC were 88.2% and 73.5%, respectively, which also did not significantly differ with the prognosis of 111 cases of stage I SPNSCLC (P=0.413, P=0.235).
Adenocarcinoma was the main pathological type among the cases with stage I SMPNSCLC. Multiple synchronous lesions almost had the malignant characteristics of primary lung cancer, particularly the presence of single or multiple sub-solid nodules. Moreover, stage I SMPNSCLC has a similar prognosis as stage I SPNSCLC. The postoperative outcomes of stage I SMPNSCLC patients remained consistent regardless of whether the 7th or 8th edition TNM staging system was used for staging.
研究报道，高达8%的非小细胞肺癌（NSCLC）存在多个病灶；尚无详细研究评估早期同步性多原发性非小细胞肺癌（SMPNSCLC）（T1N0M0、T2aN0M0）的预后。我们旨在评估I期SMPNSCLC的螺旋CT表现，并评价第7版和第8版TNM分期对预后的影响。
我们回顾性分析了2009年1月1日至2010年12月31日期间接受检查、手术且病理确诊为NSCLC并进行了5年随访的患者数据。根据第7版TNM分期系统，I期SMPNSCLC和孤立性原发性NSCLC（SPNSCLC）的病例数分别为36例和133例；根据第8版TNM分期系统，分别为34例和111例。评估了两组患者之间性别、年龄、吸烟史、肺气肿、手术方式、病理类型、肿瘤位置和肿瘤大小的关系，以及预后与第7版和第8版TNM分期的相关性。
共有1948例NSCLC患者接受了手术，其中包括36例I期SMPNSCLC（77个病灶；1.85%），发病年龄为44 - 86岁（中位年龄60岁）。肿瘤主要为腺癌（93.5%），直径为0.4 - 4.5 cm（中位值2.3 cm）。CT显示81.8%的病例为圆形/椭圆形肿瘤，79.2%的病例有分叶，70.1%的病例有毛刺征，31.2%的病例有支气管截断征，75.3%的病例有胸膜凹陷征。此外，CT显示有36个（46.8%）实性结节和41个（53.2%）亚实性结节。根据第7版TNM分期系统，I期SMPNSCLC的5年总生存率（OS）和无病生存率（DFS）分别为86.1%和72.2%，与133例I期SPNSCLC的预后相比差异无统计学意义（P = 0.587，P = 0.273）。根据第8版TNM分期系统，I期SMPNSCLC的5年OS和DFS分别为88.2%和73.5%，与111例I期SPNSCLC的预后相比差异也无统计学意义（P = 0.413，P = 0.235）。
腺癌是I期SMPNSCLC病例中的主要病理类型。多个同步病灶几乎具有原发性肺癌的恶性特征，尤其是存在单个或多个亚实性结节。此外，I期SMPNSCLC与I期SPNSCLC的预后相似。无论使用第7版还是第8版TNM分期系统对I期SMPNSCLC患者进行分期，其术后结果保持一致。
