气腔播散在多发同步双侧原发性肺癌中的意义:手术队列的预后分析
Spread through air spaces in multiple synchronous bilateral primary lung cancer: prognostic implications in a surgical cohort.
作者
作者单位
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy.
摘要
中文
多发同步双侧原发性肺癌(mSBPLC)的手术治疗显示出良好结果,本回顾性研究旨在评估其肿瘤学结局及预后不良的危险因素。纳入 2017–2024 年接受根治性(切除所有病灶)肺切除术的 mSBPLC 患者。排除标准:不适合双侧手术、肺切除术、多灶性磨玻璃影、临床分期 IIIA 及以上、术前接受治疗者。采用 Kaplan-Meier 法和 log-rank 检验进行总生存期和无病生存期分析,Cox 回归分析用于识别预后不良的预测因素。研究期间共筛查 64 例双侧肺结节患者,45 例(中位年龄 69 岁)接受 mSBPLC 手术,随访期间(中位 34 个月)观察到 11 例死亡和 15 例肿瘤复发。80% 患者主病灶为实性,对侧病灶 20% 为部分实性、20% 为纯磨玻璃影。第一次手术腺癌占 77.8%,第二次手术占 80%。气腔播散(STAS)存在于 17.8%。5 年总生存率和无病生存率分别为 77%(中位 86 个月,95%CI 72.4–99.5)和 57%(中位 69 个月,32–105.9)。比较 STAS 阳性与阴性患者的生存率,总生存期为 0% vs 85%(86 vs 29 个月,p<0.01),无病生存期为 0% vs 63%(69 vs 9 个月,p<0.01)。多因素分析显示 STAS 是较差总生存期(HR 7.08, p=0.02)和无病生存期(HR 5.63, p=0.017)的显著预测因素。考虑到研究人群较小且经过高度选择,分期双侧手术可视为安全且肿瘤学上充分的,STAS 的存在与不良长期预后相关。
English
The surgical treatment of multiple synchronous bilateral primary lung cancer (mSBPLC) showed promising results and the aims of this retrospective study were to assess the oncologic outcomes and the presence of risk factors of worse survival. Patients underwent radical (all lesions removed) lung resection for mSBPLC from 2017 to 2024 were included. Exclusion criteria: patients unfit for bilateral surgery, pneumonectomy, multifocal ground glass opacities, clinical stage IIIA or more and pre-operative treatment. Overall and disease-free survival analyses were conducted with the Kaplan-Meier method and log-rank test, Cox regression analysis was used to identify the predictors of worse survival. During the study period, 64 patients were screened for the presence of bilateral lung nodules, 45 patients (median age 69 years) were operated for mSBPLC and during the follow-up (median 34 months) we observed 11 deaths and 15 cancer recurrence. In the 80% of patients the main cancer was solid, contralateral was a part-solid in 20% or pure ground glass opacity in 20%. Adenocarcinoma was present in 77.8% at first surgery and in 80% at the second. Spread Through the Air Spaces (STAS) was present in 17.8%. The 5 year overall and disease-free survival rate were 77% (median 86 months -CI95% 72.4-99.5-) and 57% (median 69 months -32-105.9-), respectively. Comparing survivals among patients with and without STAS, we had an overall survival of 0% vs 85% (86 vs 29 months, p < 0.01) and a disease-free survival of 0% vs 63% (69 vs 9 months, p < 0.01). The multivariable analysis demonstrated STAS as significant predictor of worse overall (HR 7.08, p = 0.02) and disease-free survival (HR 5.63, p = 0.017). Taking into account the small and highly selected study population, staged bilateral surgery could be considered safe and oncologically adequate, showing the association between the presence of STAS and unfavourable long term outcomes.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q3
- 影响因子
- 1.4
- 新锐分区
- 3区