Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Thorac Cancer. 2023 Aug;14(22):2168-2176. doi: 10.1111/1759-7714.15003. Epub 2023 Jun 20.
The prognosis of miliary pulmonary metastases (MPM), which are characterized as randomly disseminated, innumerable, and small metastatic nodules, has been considered as being poor. The purpose of this study was to evaluate the clinical characteristics and survival of MPM in patients with non-small cell lung cancer (NSCLC).
This retrospective study included NSCLC patients with MPM and nonmiliary pulmonary metastases (NMPM) detected during staging evaluation between 2000 and 2020. MPM was defined as >50 bilaterally distributed metastatic pulmonary nodules (<1 cm in diameter), and NMPM was defined as the presence of ≤15 metastatic pulmonary nodules regardless of size. Baseline characteristics, genetic alterations and overall survival (OS) rates were compared between the two groups.
Twenty-six patients with MPM and 78 patients with NMPM were analyzed. The median number of patients who smoked was significantly lower in the MPM group than in the NMPM group (0 vs. 8 pack years, p = 0.030). The frequency of EGFR mutation was significantly higher in the MPM group (58%) than in the NMPM group (24%; p = 0.006). There was no significant difference in 5-year OS between the MPM and the NMPM group by the log-rank test (p = 0.900).
MPM in NSCLC were significantly related to EGFR mutation. The OS rate of the MPM group was not inferior to that of the NMPM group. The presence of EGFR mutations should be thoroughly evaluated for NSCLC patients with initial presentation of MPM.
广泛肺转移（MPM）表现为随机分布、无数个且微小的转移结节，其预后一直被认为较差。本研究旨在评估非小细胞肺癌（NSCLC）患者中 MPM 的临床特征和生存情况。
本回顾性研究纳入了 2000 年至 2020 年分期评估期间发现 MPM 和非广泛肺转移（NMPM）的 NSCLC 患者。MPM 定义为>50 个双侧分布的转移性肺结节（<1cm 直径），NMPM 定义为存在≤15 个转移性肺结节，无论大小。比较两组间的基线特征、基因改变和总生存（OS）率。
共分析了 26 例 MPM 患者和 78 例 NMPM 患者。MPM 组患者中位吸烟量显著低于 NMPM 组（0 与 8 包年，p=0.030）。EGFR 突变在 MPM 组（58%）的频率显著高于 NMPM 组（24%；p=0.006）。Log-rank 检验显示 MPM 组与 NMPM 组 5 年 OS 无显著差异（p=0.900）。
NSCLC 中的 MPM 与 EGFR 突变显著相关。MPM 组的 OS 率并不劣于 NMPM 组。对于初始表现为 MPM 的 NSCLC 患者，应彻底评估 EGFR 突变情况。
