Surgical Treatment and Prognosis for Patients with Synchronous Multiple Primary Lung Adenocarcinomas

: 背景与目的 随着高分辨率计算机断层扫描（high-resolution computed tomography, HRCT）应用的普及，多原发肺癌（multiple primary lung cancers, MPLC）的检出率逐年上升，其中腺癌是最常见的病理类型。目前国内外对MPLC的研究已相对多见，但罕有单独分析同时性多原发肺腺癌（synchronous multiple primary lung adenocarcinomas, SMPLA）的报道。本研究探讨SMPLA患者的临床病理特点及预后，旨在提高对SMPLA的认识。方法 对2012年12月-2016年7月期间我科38例临床资料保存完整的SMPLA患者进行了回顾性分析。结果 38例SMPLA患者中，男性12例，女性26例，中位年龄为58岁（39岁-73岁）。双原发肺腺癌29例，2个病灶以上9例。病灶位于同侧26例，双侧12例。同期手术34例（包括8例患者同期行双侧手术），分期手术4例。5例患者对每个病灶分别行基因检测，结果证实不同病灶的表皮生长因子受体（epidermal growth factor receptor, EGFR）基因突变类型不完全相同。1年和3年总生存率分别为96.6%和74.2%。肿瘤直径越大（P<0.001）、T分期越高（P=0.003）、淋巴结转移（P=0.001）、TNM分期越高（P=0.022）以及术后放、化疗（P=0.009）提示总生存预后较差。结论 对于多发的非小细胞肺癌，不能轻易地诊断为转移癌，应考虑多原发可能。EGFR基因检测可作为鉴别多原发肺腺癌与复发转移癌的临床参考。. METHODS: Data from 38 patients undergoing surgery for SMPLA in our institution frrom December 2012 and July 2016 were retrospectively collected. RESULTS: Among the 38 patients, 12 patients were male, 26 patients were female, with a median age of 58 (ranging from 39 to 73). Surgical outcomes verified 29 patients with 2 tumors and 9 patients with more than 2 tumors. There were 26 patients with tumors in ipsilateral lung while 12 patients in contralateral lung. Eight patients underwent one-stage surgical treatment for contralateral tumors with mean postoperative hospitalization of 10 days. The gene detection results of 5 patients showed different epidermal growth factor receptor (EGFR) mutations can be found in one patient's different tumors. The 1-year and 3-year overall survival (OS) rate were 96.6% and 74.2%. Larger maximal tumor dimension (P<0.001), advanced pT stage (P=0.003), lymph nodes metastases positive (P=0.001), advanced TNM stage (P=0.022) and postoperative adjuvant chemoradiotherapy (P=0.009) were correlated with poor OS. CONCLUSIONS: Multiple lung malignant lesions should not be taken as metastasis for granted and the possibility of MPLC also should be considered. Mutational status of EGFR could be used as a clinical reference to diagnose patients with SMPLA.