Department of Thoracic and Cardiovascular Surgery, Chung-ang University Hospital, Seoul, Korea.
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Surg Oncol. 2024 Jan;31(1):201-212. doi: 10.1245/s10434-023-14373-8. Epub 2023 Oct 9.
Invasive mucinous adenocarcinoma (IMA) is distinct from non-mucinous adenocarcinoma, but studies on recurrent IMA are scarce. Thus, this study aimed to evaluate the recurrence patterns of IMA and the role of pulmonary local therapy (LT) in resectable pulmonary recurrence of IMA.
The study reviewed 403 patients with surgically resected IMA between 1998 and 2018. The recurrence patterns were categorized as solitary pulmonary recurrence (SPR), multiple pulmonary recurrence (MPR), and extra-pulmonary recurrence (EPR). The clinicopathologic characteristics, overall survival (OS), and post-recurrence survival (PRS) were analyzed according to the recurrence pattern and LT administration.
Recurrences were found in 91 (22.6%) patients, including 18 patients with SPR, 37 patients with MPR, and 36 patients with EPR. Compared with the MPR and EPR groups, the SPR group had a longer disease-free interval (32.5 vs. 9.6 vs. 10.1 months, respectively; p < 0.01) and a better OS (5-year OS: 88.5%, 41.5%, and 22.9%, respectively; p < 0.01). In case of resectable pulmonary recurrence, pulmonary LT was administered to 15 patients with SPR and 3 patients with MPR. These patients showed a better 5-year PRS than the other patients with pulmonary recurrence (86.3% vs. 30.4%; p < 0.01). Notably, long-term survival was observed for one patient with MPR undergoing LT and two patients with SPR undergoing a second LT for a second pulmonary recurrence.
In this series, the patients with recurrent IMA showed different prognoses according to the recurrence pattern. The patients with pulmonary recurrence of IMA undergoing LT showed a favorable prognosis, suggesting the potential role of LT for resectable pulmonary recurrence of IMA.
浸润性黏液性腺癌（IMA）与非黏液性腺癌不同，但关于复发性 IMA 的研究较少。因此，本研究旨在评估 IMA 的复发模式以及肺局部治疗（LT）在可切除肺复发 IMA 中的作用。
本研究回顾了 1998 年至 2018 年间接受手术切除的 403 例 IMA 患者。根据复发模式和 LT 管理，将复发模式分为孤立性肺复发（SPR）、多发性肺复发（MPR）和肺外复发（EPR）。分析了根据复发模式和 LT 管理的临床病理特征、总生存期（OS）和复发后生存期（PRS）。
91 例（22.6%）患者出现复发，其中 18 例为 SPR，37 例为 MPR，36 例为 EPR。与 MPR 和 EPR 组相比，SPR 组无病间隔时间更长（分别为 32.5、9.6 和 10.1 个月；p < 0.01），OS 更好（5 年 OS：分别为 88.5%、41.5%和 22.9%；p < 0.01）。对于可切除的肺复发，15 例 SPR 和 3 例 MPR 患者接受了肺 LT。这些患者的 5 年 PRS 优于其他肺复发患者（86.3%比 30.4%；p < 0.01）。值得注意的是，1 例 MPR 患者接受 LT 治疗和 2 例 SPR 患者接受 LT 治疗第二肺复发后长期生存。
在本系列中，复发性 IMA 患者根据复发模式表现出不同的预后。接受 LT 的 IMA 肺复发性患者预后良好，提示 LT 对可切除性肺复发性 IMA 具有潜在作用。
