Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
Ann Surg Oncol. 2018 May;25(5):1237-1244. doi: 10.1245/s10434-018-6360-6. Epub 2018 Feb 7.
Defining the status of solitary pulmonary lesion (SPL) in patients with history of malignancy is important because primary lung cancer (PLC) or intrapulmonary metastasis might indicate different surgical strategies. The aim of this study is to identify factors related to the status of these lesions and construct a clinical model to estimate the pretest probability of PLC.
From January 2005 to January 2016, 104 patients with previous malignancy and suitable for surgery were retrospectively studied. Univariate and multivariate analyses were performed to identify possible factors related to SPLs. A nomogram was constructed to differentiate PLC from intrapulmonary metastasis.
Ninety-seven (93.3%) patients were diagnosed as malignant postoperatively, including 61 patients with intrapulmonary metastasis and 36 patients with PLC. Multivariate analysis showed that site of primary tumor [head and neck squamous cell cancer: odds ratio (OR) = 28.509, P = 0.006; genitourinary cancer: OR = 23.928, P = 0.012], negative lymph node status of primary tumor (OR = 3.154, P = 0.038), spiculation of SPL (OR = 3.972, P = 0.022), and central location of SPL (OR = 4.679, P = 0.026) were four independent factors differentiating PLC from intrapulmonary metastasis. All of these were included in the nomogram. The C-index of the nomogram for predicting probability was 0.82.
Incidence of malignant SPLs was fairly high in patients with history of malignancy. A nomogram including site and lymph node status of primary tumor, and spiculation and location of SPL might be a good tool for differentiating PLC from intrapulmonary metastasis preoperatively and guiding treatment.
对于有恶性肿瘤病史的患者，明确孤立性肺病变（SPL）的性质非常重要，因为原发性肺癌（PLC）或肺内转移可能提示不同的手术策略。本研究旨在确定与这些病变性质相关的因素，并构建一个临床模型来估计 PLC 的术前可能性。
回顾性分析 2005 年 1 月至 2016 年 1 月期间 104 例有恶性肿瘤病史且适合手术的患者。进行单因素和多因素分析以确定与 SPL 相关的可能因素。构建列线图以区分 PLC 和肺内转移。
97 例（93.3%）患者术后诊断为恶性，其中 61 例为肺内转移，36 例为 PLC。多因素分析显示，原发肿瘤部位[头颈部鳞状细胞癌：比值比（OR）=28.509，P=0.006；泌尿生殖系统癌：OR=23.928，P=0.012]、原发肿瘤淋巴结阴性状态（OR=3.154，P=0.038）、SPL 分叶征（OR=3.972，P=0.022）和 SPL 中央位置（OR=4.679，P=0.026）是区分 PLC 和肺内转移的四个独立因素。所有这些因素均纳入列线图。预测概率的列线图 C 指数为 0.82。
有恶性肿瘤病史的患者中恶性 SPL 的发生率相当高。包括原发肿瘤部位和淋巴结状态、分叶征和 SPL 位置的列线图可能是术前区分 PLC 和肺内转移并指导治疗的有用工具。
