Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China.
Ann Thorac Surg. 2020 Mar;109(3):856-863. doi: 10.1016/j.athoracsur.2019.09.088. Epub 2019 Nov 22.
To determine oncologic and surgical outcomes after multiple pulmonary resections (MPR) for synchronous or metachronous lung cancer with multiple pulmonary sites of involvement and to identify prognostic factors for these patients.
We retrospectively analyzed data from two Chinese high-volume institutions. Eligible patients underwent MPR for synchronous or metachronous lung cancer with multiple pulmonary sites of involvement. Overall survival and disease-free survival after MPR were analyzed, and prognostic factors were explored using multivariable Cox analysis. Postoperative mortality and major morbidities within 30 days were evaluated.
In total, 142 patients were included: 36 (25%) underwent MPR for the metachronous disease, and 106 (75%) underwent MPR for the synchronous disease. Five-year disease-free survival was 85.4% for the metachronous group and 69.1% for the synchronous group; 5-year overall survival was 86.1% and 84.8%, respectively. Five-year accumulated local and distant recurrence rates were 11.9% and 3.0% for the metachronous group and 26.6% and 5.9% for the synchronous group, respectively. In the synchronous MPR group, a larger sum of tumor size (hazard ratio [HR] 1.04; 95% confidence interval [CI], 1.00 to 1.08) and regional nodal involvement (HR 6.17; 95% CI, 1.42 to 35.46) were both independently associated with worse overall survival. In the metachronous MPR group, the longer disease-free interval was independently associated with favorable overall survival (HR 0.94; 95% CI, 0.88 to 0.98) and disease-free survival (HR 0.96; 95% CI, 0.93 to 0.99). There was no 30-day mortality. The overall rate of major morbidities was 12%.
Multiple pulmonary resection is valid for patients with synchronous and metachronous lung cancer with multiple pulmonary sites of involvement.
为了确定多个肺部位受累的同步或异时性肺癌患者多次肺切除（MPR）后的肿瘤学和手术结果，并确定这些患者的预后因素。
我们回顾性分析了来自两家中国高容量机构的数据。符合条件的患者接受了多个肺部位受累的同步或异时性肺癌的 MPR。分析了 MPR 后的总生存率和无病生存率，并使用多变量 Cox 分析探讨了预后因素。评估了术后 30 天内的死亡率和主要并发症。
共纳入 142 例患者：36 例（25%）因异时性疾病行 MPR，106 例（75%）因同步性疾病行 MPR。异时组的 5 年无病生存率为 85.4%，同步组为 69.1%；5 年总生存率分别为 86.1%和 84.8%。异时 MPR 组的局部和远处复发累积率分别为 11.9%和 3.0%，而同步 MPR 组分别为 26.6%和 5.9%。在同步 MPR 组中，肿瘤大小总和（风险比 [HR] 1.04；95%置信区间 [CI]，1.00 至 1.08）和区域淋巴结受累（HR 6.17；95%CI，1.42 至 35.46）均与总体生存率较差独立相关。在异时 MPR 组中，无病间隔时间较长与总生存率（HR 0.94；95%CI，0.88 至 0.98）和无病生存率（HR 0.96；95%CI，0.93 至 0.99）的改善独立相关。没有 30 天死亡率。主要并发症的总发生率为 12%。
多次肺切除术对多个肺部位受累的同步或异时性肺癌患者是有效的。
