30例双原发肺癌的临床及预后因素分析

摘要

背景与目的 多原发肺癌(multiple primary lung cancer, MPLC)是一种临床中较为少见的肺癌类型,双原发肺癌(double primary lung cancer, DPLC)是其中最常见的一种,近年来由于诊疗手段的进步检出率逐渐升高.本研究总结分析了30例DPLC患者的临床资料,以期为DPLC的诊疗提供理论依据.方法 回顾郑州大学附属肿瘤医院2010年1月-2015年12月收治的30例DPLC患者的临床资料,对临床特征及预后相关因素进行分析.结果 30例中,同时性双原发癌(synchronous DPLC, sDPLC)占3例(3/30, 10%),异时性双原发癌(metachro-nous DPLC, mDPLC)占27例(27/30, 90.0%).病灶好发于右肺上叶(20/60, 33.3%),病理类型以腺癌(25/60, 41.7%)为主,病理类型相同者(17/30, 56.7%)多于不同者(13/30, 43.3%),病理类型相同者以腺-腺(10/16, 62.5%)最常见.生存分析显示淋巴结转移(HR=4.349, 95%CI: 1.435-13.178, P=0.009)和重度吸烟史(HR=2.996, 95%CI: 1.089-8.240, P=0.034)是DPLC的不良预后因素.结论 DPLC好发于右肺上叶,病理类型以腺癌为主,早期诊断、积极的治疗和严格的戒烟策略有望改善其预后.%Background and objective Multiple primary lung cancer (MPLC) represents a rare variety of pulmonary malignant tumor while mainly consist of double primary lung cancer (DPLC), but the development of diag-nostic techniques promotes the rate diagnosis of it in recent years. Here we summarize and anylasis the data of 30 cases with DPLC in expectation of improving congnitive of MPLC. Methods We retrospectly studied 30 MPLC patients who diagnosed from January 2010 to December 2015 in Affiliated Cancer Hospital of Zhengzhou University. The clini-cal characteristics, diagnosis, therapeutic methods and prognosis were analyzed. Results Among 30 patients enrolled, metachronous DPLC (27/30, 90%) is far more common than synchronous DPLC. The majority of the lesions located at right upper lobe (20/60, 33.3%), and adenocarcinoma (25/60, 41.7%) turns out to be the major pathological pat-ter. Patients with same pathological pattern of two lesions of DPLC (17/30, 56.7%) were slightly more than those with different pattern(13/30,43.3%)and adeno-adeno was the most common pattern in the former ones.Cox regression anylasis shows that lymphatic metastasis (HR=4.349, 95%CI: 1.435-13.178, P=0.009) and experience of heavy smok-ing (HR=2.996, 95%CI: 1.089-8.240, P=0.034) were associate with worse prognosis. Conclusion DPLC are mainly located at right upper lobe, and mostly adenocarcinomas. Earlier diagnosis, active therapeutic approaches and a strict smoking cessation strategy may improve the prognosis of MPLC.