Antakli T, Schaefer R F, Rutherford J E, Read R C
Surgical Service, John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas 72205.
Ann Thorac Surg. 1995 Apr;59(4):863-6; discussion 867. doi: 10.1016/0003-4975(95)00067-u.
We reviewed our experience with second primary lung cancer (SPLC) at the Little Rock Veterans Affairs Medical Center from 1966 to 1993. Fifty-four patients were found to have 65 such lesions after 1,572 "curative" resections for lung cancer (4.1%). Eleven patients had at least a third primary tumor (3 having more). Metachronous SPLCs comprised 60% (39/65) and synchronous 40% (26/65). The mean interval between first and second tumors was 54.63 +/- 8 (standard error) months (range, 5 to 218 months), and that between second and third was 26.1 +/- 7.4 (standard error) (range, 5.5 to 51 months). Squamous cell carcinoma comprised 58.4% (38/65), adenocarcinoma 30.8% (20/65), and small cell carcinoma 10.8% (7/65). Histology of the SPLC was the same as that of the first tumor in 50.7% (33/65). Stage I primary tumors comprised 76% (41/54) of index tumors, 61.1% (33/54) of SPLCs, and 72.2% (8/11) of third primary tumors. Second primary lung cancer followed minimal resection in 44% (24/54), lobectomy in 37% (20/54), and pneumonectomy in 13% (7/54) of cases. There was no evidence that minimal resection for the first primary tumor predisposed to SPLC. After 1983 the majority of SPLCs were diagnosed with computed tomographic scanning. After resection of SPLCs, survival rates at 3 and 5 years were 26% and 18%, metachronous 39% and 23.4%, and synchronous 12.25% and 12.25%.
我们回顾了1966年至1993年期间在小石城退伍军人事务医疗中心诊治第二原发性肺癌（SPLC）的经验。在1572例肺癌“根治性”切除术后，发现54例患者有65个此类病变（4.1%）。11例患者至少有第三个原发性肿瘤（3例有更多）。异时性SPLC占60%（39/65），同时性占40%（26/65）。第一和第二个肿瘤之间的平均间隔为54.63±8（标准误）个月（范围5至218个月），第二和第三个肿瘤之间的平均间隔为26.1±7.4（标准误）（范围5.5至51个月）。鳞状细胞癌占58.4%（38/65），腺癌占30.8%（20/65），小细胞癌占10.8%（7/65）。50.7%（33/65）的SPLC组织学与第一个肿瘤相同。I期原发性肿瘤在索引肿瘤中占76%（41/54），在SPLC中占61.1%（33/54），在第三个原发性肿瘤中占72.2%（8/11）。44%（24/54）的病例中第二原发性肺癌发生在肺叶部分切除术后，37%（20/54）发生在肺叶切除术后，13%（7/54）发生在全肺切除术后。没有证据表明第一个原发性肿瘤的肺叶部分切除术会诱发SPLC。1983年后，大多数SPLC通过计算机断层扫描诊断。切除SPLC后，3年和5年生存率分别为26%和18%，异时性分别为39%和23.4%，同时性分别为12.25%和12.25%。
