Joubert Kyla D, Okusanya Olugbenga T, Mazur Summer, Ryan John P, Ekeke Chigozirim N, Schuchert Matthew J, Soloff Adam C, Dhupar Rajeev
Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Surgical Services Division, Veteran's Affairs Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15219, USA.
J Clin Med. 2021 Oct 22;10(21):4846. doi: 10.3390/jcm10214846.
Pleural metastasis in lung cancer found at diagnosis has a poor prognosis, with 5-11 months' survival. We hypothesized that prognosis might be different for patients who have had curative-intent surgery and subsequent pleural recurrence and that survival might differ based on the location of the first metastasis (distant versus pleural). This may clarify if pleural recurrence is a local event or due to systemic disease.
A database of 5089 patients who underwent curative-intent surgery for lung cancer was queried, and 85 patients were found who had biopsy-proven pleural metastasis during surveillance. We examined survival based on pattern of metastasis (pleural first versus distant first/simultaneously).
Median survival was 34 months (range: 1-171) from the time of surgery and 13 months (range: 0-153) from the time of recurrence. The shortest median survival after recurrence was in patients with adenocarcinoma and pleural metastasis as the first site (6 months). For patients with pleural metastasis as the first site, those with adenocarcinoma had a significantly shorter post-recurrence survival when compared with squamous cell carcinoma (6 vs. 12 months; HR = 0.34) and a significantly shorter survival from the time of surgery when compared with distant metastases first/simultaneously (25 vs. 52 months; HR = 0.49).
Patients who undergo curative-intent surgery for lung adenocarcinoma that have pleural recurrence as the first site have poor survival. This may indicate that pleural recurrence after lung surgery is not likely due to a localized event but rather indicates systemic disease; however, this would require further study.
肺癌诊断时发现的胸膜转移预后较差，生存期为5 - 11个月。我们推测，接受根治性手术及随后发生胸膜复发的患者预后可能不同，且生存期可能因首次转移部位（远处转移与胸膜转移）而异。这可能有助于明确胸膜复发是局部事件还是由全身性疾病所致。
查询了一个包含5089例接受肺癌根治性手术患者的数据库，发现85例在监测期间经活检证实有胸膜转移的患者。我们根据转移模式（胸膜首发与远处首发/同时发生）研究了生存期。
从手术时起的中位生存期为34个月（范围：1 - 171个月），从复发时起为13个月（范围：0 - 153个月）。复发后中位生存期最短的是腺癌且胸膜转移为首发部位的患者（6个月）。对于胸膜转移为首发部位的患者，腺癌患者复发后的生存期明显短于鳞状细胞癌患者（6个月对12个月；风险比=0.34），且从手术时起的生存期明显短于远处转移首发/同时发生的患者（25个月对52个月；风险比=0.49）。
以胸膜复发为首发部位接受肺癌根治性手术的患者生存期较差。这可能表明肺癌手术后的胸膜复发不太可能是局部事件，而更可能提示全身性疾病；然而，这需要进一步研究。
