41例可手术多原发肺癌临床分析

背景与目的：多原发肺癌(multiple primary lung cancers，MPLC)是原发性肺癌中的一种少见类型，但近年临床检出率呈逐渐升高的趋势。本研究对41例MPLC的临床资料进行总结分析，进一步探讨MPLC的诊断、治疗和预后。方法：参照Martini-Melamed诊断标准，对41例MPLC的临床病理资料进行回顾性分析。结果：41例患者中三原发肺癌3例，双原发肺癌38例。同时性MPLC13例，异时性MPLC26例，同时性MPLC+异时性MPLC2例。手术方式以肺叶切除为主(78.8%，67/85)，病灶好发于右上叶(41.2%，35/85)，病理以腺癌多见(70.6%，60/85)，其次为鳞癌(17.6%，15/85)。腺癌亚组中以乳头状为主的病理亚型比率较高(50%，30/60)。分期以I期为主(80%，68/85)。组织病理类型相同的MPLC比例(68.3%，28/41)高于不同病理类型(31.7%，13/41)，其中腺癌-腺癌多见(82.1%，23/28)。病灶位于同侧不同肺叶者4例(9.8%)，位于双侧肺者37例(90.2%)。MPLC2年总生存(overall survival，OS)率为87.8%(36/41)，生存分析显示病理类型相同组较不同组预后好(P=0.037)，无淋巴结转移的MPLC较有淋巴结转移组预后好(P=0.02)。结论：MPLC病灶好发于右上叶，病理以腺癌最常见，乳头状为主的病理亚型多见。其早期检出率越来越高，采取积极的手术治疗可获得较为理想的预后。

Clinical analysis of 41 cases with resected multiple primary lung cancers

Background and purpose: Multiple primary lung cancers (MPLC) is a rare entity, but recently there has been a gradual increase in the number of patients diagnosed with MPLC. The aim of this study is to investigate the diagnosis, treatment and prognosis of MPLC through analyzing the clinical data. Methods: Forty-one patients were diagnosed MPLC by Martini-Melamed criteria. Their clinicopathological data were retrospectively reviewed. Results: There were 3 patients with triple primary lung cancer and 38 patients with double primary lung cancer. There were 13 patients with synchronous MPLC, 26 patients with metachronous MPLC, 2 patients with synchronous and metachronous MPLC. Of 85 lesions, the surgical procedures were mainly lobectomy (78.8%, 67/85). Lesions (41.2%, 35/85) were frequently in right upper lobe. Pathological type was mainly adenocarcinoma (70.6%, 60/85), followed by squamous cell carcinoma (17.6%, 15/85). Of 60 adenocarcinoma specimens, the papillary predominant subtype was more common (50%, 30/60). Eighty percent (68/85) of the lesions were stage I. As to the initial cancer and repeated cancer, patients who shared the same pathological type (68.3%, 28/41) were more than the different (31.7%, 13/41), of which adenocarcinoma-adenocarcinoma was most common(82.1%, 23/28). Lesions located in contralateral lobes were in 37 patients (90.2%), and located in ipsilateral different lobes were in 4 patients (9.8%). The 2-year overall survival (OS) of them was 87.8%. Survival analysis showed that the prognosis of patients with same pathological type was better than patients with different pathological type (P=0.037), the prognosis of patients with no lymph node metastasis was better than patients with N1, N2 metastasis (P=0.02). Conclusion: Lesions in patients with multiple primary lung cancers are more frequently in the right upper lobes. The pathology type is mainly adenocarcinoma, of which the papillary predominant subtype was most common. Early diagnosis improves continuously, active treatment with operation can achieve better prognosis.