同时性多原发肺癌的预后及生存相关因素研究

背景与目的同时性多原发肺癌（synchronous multiple primary lung cancer, sMPLC）既往属少见疾病，近年发病率呈持续上升趋势，但缺乏对其大样本的研究报道。本研究对357例sMPLC的临床病理资料进行分析总结，籍以为临床诊断、治疗及预后提供理论依据。方法参考Martini-Melamed诊断标准和国际肺癌研究协会（International Association for the Study of Lung Cancer, IASLC）第8版肿瘤-淋巴结-转移（tumor-node-metastasis, TNM）分期标准，对357例sMPLC的临床病理资料进行分析。结果357例患者中，双原发病灶269例（75.35%），三原发病灶65例（18.21%），四原发病灶及以上者23例（6.44%），最多者为8个病灶。病灶好发于上叶，特别是右上叶（35.77%,298/833），病理类型以腺癌为主（95.56%,796/833），鳞癌次之（2.40%,20/833），腺癌亚型中以腺泡样为主的比例较高（70.81%,313/442），分期以Ib期及以下为主（68.35%,244/357）。病理类型相同者发病率（92.72%,331/357）远高于不同病理类型（7.28%,26/357），其中腺癌-腺癌比例较高（99.40%,329/331）。sMPLC的3年总生存率（overall survival, OS）为91.93%，5年总生存率为84.37%，多因素生存分析显示，有吸烟史（P=0.012）、最大病灶直径大于2 cm（P=0.027）、淋巴结转移（P=0.015）和胸膜受累（P<0.001）为影响sMPLC预后生存的独立危险因素。结论 sMPLC好发于右上叶，以腺癌最常见，腺泡样为主的亚型多见。吸烟史、最大结节直径、淋巴结转移和胸膜侵犯是影响sMPLC预后生存的独立危险因素。早期发现和积极的手术可以使sMPLC患者获得较好的预后。

Analysis on the Prognostic and Survival Factors of Synchronous Multiple Primary Lung Cancer

Background and objective Synchronous multiple primary lung cancer (sMPLC) is a sparse disease in the past, but there has been a gradual increase in the morbidity of sMPLC recently. However, studies on large sample have never been undertaken. hTe purpose of this study is to investigate the diagnosis, treatment and prognosis of sMPLC through analyzing the clinical data, and provide supports for the management of sMPLC. Methods According to Martini-Melamed criteria, 357 patients were diagnosed sMPLC. hTe pathological staging is on the basis of the 8th edition tumor-node-metastasis (TNM) staging from International Association for the Study of Lung Cancer (IASLC). Results There were 269 patients with double primary lung cancer, 65 patients with triple primary lung cancer and 23 patients with four or more primary lung cancer. Lesions (68.55%, 571/833) were frequently in upper lobe, especially the right upper lobe. Adenocarcinoma (95.56%, 796/833) was the mainly pathological type, followed by squamous cell carcinoma (2.40%, 20/833). hTe acinar predominant subtype was the main part (70.81%, 313/442) of the all adenocarcinoma specimens. Most of the lesions (68.35%, 244/357) were stage Ib or low. Among the initial lesion and the following lesions ,patients who had the same pathological type (92.72%, 331/357) were more than the different (7.28%, 26/357), of which adenocarcinoma-adenocarcinoma occupied the major pro-portion (99.40%, 329/331). hTe 3-year overall survival (OS) and 5-year overall survival were respective 91.93%and 84.37%. Multivariate analysis found that smoking history (P=0.012), the diameter of the maximum lesion (P=0.027), lymph node me-tastasis (P=0.015) and pleural invasion (P<0.001) were the independent risk factors for prognosis. Conclusion Tumours in patients with sMPLC are more frequently in the right upper lobe. Adenocarcinoma was the mainly pathological type. Smoking history, the diameter of the maximum lesion, lymph node metastasis and pleural invasion were the independent risk factors for prognosis. Early diagnosis and active operation can obtain better prognosis.