Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2020 Nov;61(11):958-964. doi: 10.3349/ymj.2020.61.11.958.
Recent history of malignancy without 5-year disease-free interval is an absolute contraindication for lung transplantation (LTx). However, in rare cases, lung cancer may be incidentally diagnosed in the explanted lung of recipients. We evaluated the prevalence, 5-year survival, and prognosis of incidental lung cancer after LTx.
Medical records of patients who underwent LTx at Severance Hospital between January 1, 2012 and June 30, 2019 were reviewed. Patients with incidental lung cancer were included, and those with histologically proven pre-transplant lung cancer were excluded.
Of the 247 patients who underwent LTx, 6 (2.4%) were diagnosed with incidental lung cancer. Interstitial lung disease (ILD) was the underlying lung disease in all patients. The median interval from the last preoperative computed tomography (CT) screening to LTx was 26 days. The most common histological type of incidental lung cancer was adenocarcinoma (n=4, 66.7%). All Stage IV cases were misdiagnosed as fibrosis on preoperative chest CT. Patients with incidental lung cancer showed lower 5-year survival than those without malignancy (median survival: 8.5 months vs. not reached, =0.047, respectively). Patients with Stage III or IV demonstrated lower 5-year survival than those with Stage I or II and those without malignancy (median survival: 5 months, 19 months, and not reached, respectively, =0.011).
Multidisciplinary preoperative screening and serial imaging studies within short intervals are required to differentiate lung malignancy from fibrotic foci. Furthermore, active pathologic examination of suspicious lung lesions is required in patients at high risk for lung cancer.
近期无 5 年无疾病间隔期的恶性肿瘤病史是肺移植（LTx）的绝对禁忌证。然而，在极少数情况下，受体的移植肺中可能偶然诊断出肺癌。我们评估了 LTx 后偶然发现的肺癌的患病率、5 年生存率和预后。
回顾了 2012 年 1 月 1 日至 2019 年 6 月 30 日期间在 Severance 医院接受 LTx 的患者的病历。纳入偶然发现肺癌的患者，排除经组织学证实的移植前肺癌患者。
在 247 例接受 LTx 的患者中，有 6 例（2.4%）被诊断为偶然发现的肺癌。所有患者的基础肺部疾病均为间质性肺疾病（ILD）。从最后一次术前计算机断层扫描（CT）筛查到 LTx 的中位间隔时间为 26 天。偶然发现的肺癌最常见的组织学类型是腺癌（n=4，66.7%）。所有 IV 期病例在术前胸部 CT 上均误诊为纤维化。偶然发现肺癌的患者 5 年生存率低于无恶性肿瘤患者（中位生存时间：8.5 个月与未达到，=0.047）。III 期或 IV 期患者的 5 年生存率低于 I 期或 II 期患者和无恶性肿瘤患者（中位生存时间分别为 5 个月、19 个月和未达到，=0.011）。
需要进行多学科的术前筛查和短时间内的连续影像学研究，以区分肺恶性肿瘤与纤维灶。此外，对于肺癌高危患者，需要对可疑肺部病变进行积极的病理检查。
