Adebonojo S A, Moritz D M, Danby C A
Department of Cardiothoracic Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
Chest. 1997 Sep;112(3):693-701. doi: 10.1378/chest.112.3.693.
The purpose of this report is to review our experience with multiple primary lung cancers (MPLC) at the Walter Reed Army Medical Center, Washington, DC, and to determine the outcome of our surgical management of this complex problem.
The data from the Lung Cancer Registry on patients with MPLC from January 1984 to December 1995 were reviewed. We used the criteria of Martini and Melamed modified by Antakli for the diagnosis of synchronous and metachronous MPLC. Survival probabilities were calculated by the Kaplan-Meier actuarial method with the dates of resection as the starting point and included deaths from all causes. The log rank test was used to compare survival rates between groups and Wilcoxon rank sum test was used to compare the intervals between the first and the second metachronous cancers. A p value of 0.05 was considered statistically significant.
Fifty-two patients, consisting of 51 patients who had "curative" pulmonary resections and 1 patient who had radiation therapy for previous primary lung cancer, developed second or third primary lung cancers. Thirty-seven patients developed metachronous cancers within 1 to 15 years of the first operation (median, 24 months) while 15 patients had synchronous cancers (10 unilateral, 5 bilateral). The probability of cancer-free interval among patients with metachronous cancers was 41% at 3 years, 16% at 5 years, and 3% at 10 years. Two of the 36 patients who had pulmonary resection for the second metachronous cancer died in the perioperative period (operative mortality, 5.6%), and one patient had radiation therapy for the second metachronous cancer. There were no deaths among patients with synchronous cancers. The actuarial 5-year survival for second metachronous cancers was 37% and for synchronous cancers was 0%.
We conclude that an aggressive surgical approach is safe and justified in most patients with MPLC, especially patients with metachronous cancers, while patients with synchronous lung cancers have poorer prognosis. The operative morbidity and mortality are acceptable and long-term survival is possible in many patients with metachronous lung cancer.
本报告旨在回顾我们在华盛顿特区沃尔特·里德陆军医疗中心对多原发性肺癌（MPLC）的治疗经验，并确定我们对这一复杂问题的手术治疗结果。
回顾了肺癌登记处1984年1月至1995年12月期间MPLC患者的数据。我们采用了由安塔克利修改的马蒂尼和梅拉梅德标准来诊断同时性和异时性MPLC。生存概率采用Kaplan-Meier精算方法计算，以切除日期为起点，包括各种原因导致的死亡。采用对数秩检验比较组间生存率，采用Wilcoxon秩和检验比较首次和第二次异时性癌症之间的间隔时间。p值小于0.05被认为具有统计学意义。
52例患者，其中51例接受了“根治性”肺切除术，1例曾因原发性肺癌接受过放射治疗，之后发生了第二或第三原发性肺癌。37例患者在首次手术后1至15年内发生异时性癌症（中位时间为24个月），15例患者发生同时性癌症（10例单侧，5例双侧）。异时性癌症患者无癌间期的概率在3年时为41%，5年时为16%，10年时为3%。36例因第二次异时性癌症接受肺切除术的患者中有2例在围手术期死亡（手术死亡率为5.6%），1例因第二次异时性癌症接受了放射治疗。同时性癌症患者无死亡病例。第二次异时性癌症的精算5年生存率为37%，同时性癌症为0%。
我们得出结论，对于大多数MPLC患者，尤其是异时性癌症患者，积极的手术方法是安全且合理的，而同时性肺癌患者的预后较差。手术发病率和死亡率是可以接受的，许多异时性肺癌患者有可能获得长期生存。
