【摘要】：背景與目的同時性多原發(fā)肺癌(synchronous multiple primary lung cancer,sMPLC)既往屬少見疾病,近年發(fā)病率呈持續(xù)上升趨勢,但缺乏對其大樣本的研究報道。本研究對357例s MPLC的臨床病理資料進行分析總結(jié),籍以為臨床診斷、治療及預(yù)后提供理論依據(jù)。方法參考Martini-Melamed診斷標(biāo)準(zhǔn)和國際肺癌研究協(xié)會(International Association for the Study of Lung Cancer,IASLC)第8版腫瘤-淋巴結(jié)-轉(zhuǎn)移(tumor-node-metastasis,TNM)分期標(biāo)準(zhǔn),對357例sMPLC的臨床病理資料進行分析。結(jié)果 357例患者中,雙原發(fā)病灶269例(75.35%),三原發(fā)病灶65例(18.21%),四原發(fā)病灶及以上者23例(6.44%),最多者為8個病灶。病灶好發(fā)于上葉,特別是右上葉(35.77%,298/833),病理類型以腺癌為主(95.56%,796/833),鱗癌次之(2.40%,20/833),腺癌亞型中以腺泡樣為主的比例較高(70.81%,313/442),分期以Ib期及以下為主(68.35%,244/357)。病理類型相同者發(fā)病率(92.72%,331/357)遠(yuǎn)高于不同病理類型(7.28%,26/357),其中腺癌-腺癌比例較高(99.40%,329/331)。sMPLC的3年總生存率(overall survival,OS)為91.93%,5年總生存率為84.37%,多因素生存分析顯示,有吸煙史(P=0.012)、最大病灶直徑大于2 cm(P=0.027)、淋巴結(jié)轉(zhuǎn)移(P=0.015)和胸膜受累(P0.001)為影響sMPLC預(yù)后生存的獨立危險因素。結(jié)論 sMPLC好發(fā)于右上葉,以腺癌最常見,腺泡樣為主的亞型多見。吸煙史、最大結(jié)節(jié)直徑、淋巴結(jié)轉(zhuǎn)移和胸膜侵犯是影響sMPLC預(yù)后生存的獨立危險因素。早期發(fā)現(xiàn)和積極的手術(shù)可以使sMPLC患者獲得較好的預(yù)后。
[Abstract]:Background & objective simultaneous multiple primary lung cancer (synchronous multiple primary lung cancer MPLC) is a rare disease in the past. The incidence of MPLCs has been increasing in recent years, but there is no report on its large sample. In this study, the clinicopathological data of 357 cases of s MPLC were analyzed and summarized to provide theoretical basis for clinical diagnosis, treatment and prognosis. Methods according to the diagnostic criteria of Martini-Melamed and tumor-node-lymph node metastasis (TNM) staging criteria of (International Association for the Study of Lung Cancer IASLC, the clinicopathological data of 357 cases of sMPLC were analyzed. Results among 357 patients, 269 cases (75.35%) had double primary lesions, 65 cases (18.21%) had three primary lesions, 23 cases (6.44%) had four or more primary lesions, and 8 lesions were the most common. The lesions mainly occurred in the upper lobe, especially in the right superior lobe (35.7778 / 833). The pathological types were mainly adenocarcinoma (95.56A / 796 / 833), squamous cell carcinoma (2.40C / 20 / 833), acinar subtype (70.81313 / 442), and stage Ib (68.35 / 24447). The incidence rate of the same pathological type (92.72and 331- 357) was much higher than that of the different pathological types (7.280.26 / 357), in which the ratio of adenocarcinoma to adenocarcinoma was higher (99.4040 / 329 / 331) .sMPLC had a overall survival OS of 91.93, and a 5-year overall survival rate of 84.377.Multivariate survival analysis showed that Smoking history (P0. 012), maximum lesion diameter more than 2 cm (P0. 027), lymph node metastasis (P0. 015) and pleural involvement (P0. 001) were independent risk factors for the survival of sMPLC. Conclusion sMPLC usually occurs in the upper right lobe, adenocarcinoma is the most common and acinar subtype is more common. Smoking history, maximum nodule diameter, lymph node metastasis and pleural invasion were independent risk factors for survival of sMPLC. Early detection and active surgery can lead to better prognosis in patients with sMPLC.
【作者單位】： 上海交通大學(xué)附屬胸科醫(yī)院/上海市肺部腫瘤臨床醫(yī)學(xué)中心;
【分類號】：R734.2

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