Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York.
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York.
Ann Thorac Surg. 2019 Dec;108(6):1724-1728. doi: 10.1016/j.athoracsur.2019.06.023. Epub 2019 Jul 31.
Patients who have undergone curative surgery for stage I lung cancer require continued surveillance owing to the risk of a second primary lung cancer developing. Early diagnosis allows for prompt intervention. However, as in primary cancers, the role of wedge vs lobar resections remains controversial.
The Surveillance Epidemiology and End Results database was examined from 2004 to 2012 and all pathologically proven stage I lung cancer patients who underwent cancer-directed surgery were selected. Cases in which a second primary lung cancer developed 6 or more months after diagnosis of the first cancer were analyzed for survival after surgical treatment.
Second primary lung cancer was identified in 625 patients, of whom 331 (53%) were diagnosed with stage I disease; 43.8% of patients underwent surgery alone, 30.9% received radiation alone, and 21.0% received neither surgery nor radiation. Of the patients who underwent surgery, 57.7% received wedge resection and 36.5% received a lobectomy. Surgical intervention was a positive predictor of survival-both wedge resection and lobectomy exhibited improved outcomes vs no surgery-but there was no statistically significant difference between the two surgical modalities.
Wedge and lobar resections demonstrate similar survival for second primary lung cancers.
接受 I 期肺癌根治性手术的患者由于存在发生第二原发性肺癌的风险，需要持续监测。早期诊断可以及时进行干预。然而，与原发性癌症一样，楔形切除术与肺叶切除术的作用仍存在争议。
对 2004 年至 2012 年的监测、流行病学和最终结果数据库进行了检查，选择了所有经病理证实为 I 期肺癌且接受癌症定向手术的患者。对在首次癌症诊断后 6 个月或更长时间发生第二原发性肺癌的病例进行了分析，以评估手术治疗后的生存情况。
在 625 例患者中发现了第二原发性肺癌，其中 331 例（53%）诊断为 I 期疾病；43.8%的患者单独接受了手术治疗，30.9%的患者单独接受了放疗，21.0%的患者既未接受手术也未接受放疗。在接受手术的患者中，57.7%接受了楔形切除术，36.5%接受了肺叶切除术。手术干预是生存的积极预测因素——楔形切除术和肺叶切除术均优于未手术治疗——但两种手术方式之间无统计学差异。
楔形切除术和肺叶切除术在治疗第二原发性肺癌时具有相似的生存结果。
