Kanai Risa, Tane Kenta, Ishii Genichiro, Suzuki Jun, Sakai Takashi, Okada Satoshi, Miyoshi Tomohiro, Aokage Keiju, Tsuboi Masahiro
Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan.
Jpn J Clin Oncol. 2018 Dec 1;48(12):1083-1087. doi: 10.1093/jjco/hyy146.
Gastric cancer metastasis to the lung can rarely manifest as solitary pulmonary nodule. The surgical strategies are different between metastasis from gastric cancer and primary lung cancer; therefore, the clinical prediction of solitary pulmonary nodule is important.
Between September 2006 and September 2016, 38 patients with a history of curative resection for gastric cancer who subsequently underwent lung resection for solitary pulmonary nodule at our institution were evaluated. We retrospectively reviewed clinical characteristics in order to investigate clinical predictors for diagnosis and appropriate operative strategies.
Nodules were shown to be 9 metastasis from gastric cancer, 26 primary lung cancer and 3 benign tumors. Between metastasis from gastric cancer and primary lung cancer, there was a significant difference in age (P = 0.013), surgical procedure used for gastrectomy (P = 0.018) and pathological stage of gastric cancer (P = 0.031). All eight patients who had undergone endoscopic resection for gastric cancer and all 10 patients whose pulmonary nodules were detected more than 5 years after gastrectomy were diagnosed as primary lung cancer. Regarding the prognosis after lung resection, at a median follow-up of 29.3 months, the median survival time in patients with metastasis from gastric cancer was 19.7 months (range, 10.2-63.7 months), whereas that was not reached in patients with primary lung cancer.
Solitary pulmonary nodule in patients with a history of pathological stage I gastric cancer may be suspected as primary lung cancer, and an anatomical lung resection should be considered positively. In the case of solitary pulmonary nodule suspected metastasis from gastric cancer from clinical characteristics, a limited resection may be considered, and metastasectomy can potentially result in long-term survival.
胃癌转移至肺很少表现为孤立性肺结节。胃癌转移与原发性肺癌的手术策略不同，因此，孤立性肺结节的临床预测很重要。
2006年9月至2016年9月期间，对我院38例有胃癌根治性切除病史、随后因孤立性肺结节接受肺切除的患者进行了评估。我们回顾性分析了临床特征，以研究诊断的临床预测因素和合适的手术策略。
结节显示为9例胃癌转移、26例原发性肺癌和3例良性肿瘤。胃癌转移与原发性肺癌之间，在年龄（P = 0.013）、胃癌切除所用手术方式（P = 0.018）和胃癌病理分期（P = 0.031）方面存在显著差异。所有8例行胃癌内镜切除的患者以及所有10例在胃癌切除术后5年以上发现肺结节的患者均被诊断为原发性肺癌。关于肺切除术后的预后，中位随访29.3个月时，胃癌转移患者的中位生存时间为19.7个月（范围10.2 - 63.7个月），而原发性肺癌患者未达到中位生存时间。
有病理I期胃癌病史的患者出现孤立性肺结节，可能怀疑为原发性肺癌，应积极考虑行解剖性肺切除。对于根据临床特征怀疑为胃癌转移的孤立性肺结节病例，可考虑行局限性切除，转移灶切除术有可能带来长期生存。
