讲者 6 陈海泉-王瑞-多发GGO-

以多发磨玻璃结节为表现的肺腺癌-临床病理特征、治疗及预后

王瑞

上海市胸科医院

Background

•Dis0nguishingsynchronousprimarylungcancers(SPLCs)fromintrapulmonarymetastasisisimportant

•Prognosisandtreatmentsareverydifferent

•SurgicalapproachtoSPLCmayresultinprolongedsurvival.

CurrentmethodsdeterminingSPLC

mainlyrelyonpathologicalexamination

ofresectedspecimens

JTCVS1975;AJSP2009;JTO2009;CHEST2010;ERJ2012;JCO2014;ASO2014

Background

•Howtoiden0fySPLCbeforesurgery—inordertodevelopanappropriatetreatmentplanontheini0alpercep0onofthedisease—ischallenging.

•Mul0pleground-glassopaci0es(GGOs)detectedbyCTinasymptoma0cpa0ent.

PureGGO

MalignantGGO

AIS

MIA

LepidicAD

AAH

MixGGO

Background

Hypothesis:

•mul0pleGGOsmightbeauniquesubtypeofNSCLC

•oneofthesignsugges0ngSPLCsandwarrantsurgery.

Pa0entsandMethods

•2007.06-2014.12database

–consecu0vepa0entswithpulmonarytumors

–AlltumorR0resected

–Primaryadenocarcinomaconfirmedbypathology

•GGOdefini0on

–TwothoracicradiologistsblindlyinterpretedthescanimagesfromchestCT(64-row;slicewidth,1.0mm).

–LesionswithGGOcomponents

–IncludingpureGGOandmixedGGO

Pa0entsandMethods

•Mul0-GGOvsSingleadenocarcinoma(ADC)

–clinicopathologiccharacteris0cs

–Inves0gatethedriver-muta0onalstatusofthepairedGGOlesions

–Es0matethecura0veeffectofsurgery.

结果

•AllADCpa0entsN=1205

SingleADCN=1042

Mul0pleGGOsN=163(13.5%)

Results

Characteris*cs

Mul*pleGGOs(N=163)

SingleADC

(N=1042)

P

Gender(male/female)

50/113

479/563

<.001

Age(mean±SD,yrs)

59.2±10.0

59.6±9.9

0.6366

Smokinghistory

30(18.4%)

348(33.4%)

<.001

Historyofothermalignanttumors

29(17.8%)

98(9.4%)

.001

Familyhistoryofmalignanttumors

58(35.6%)

257(24.7%)

.001

Results

PrimaryTumor

(N=163)

2edTumor(N=163)

3rdTumor

(N=9)

Size(Mean±SD,mm)

16.7±11.3

7.2±5.7

5.7±3.5

Loca*on(%)

Samelobe

39

2

Ipsilaterallobe

80

3

Contralaterallobe

44

4

Surgicalprocedure(%)

Lobectomy

143

47

2

Segmentectomy

2

9

2

Wedgeresec*on

18

107

5

Therewere116pa0ents(71.2%)underwentatleastone

sublobarresec0on.

Percentage%

50

45

40

35

30

25

20

15

10

5

0

7.8

2.7

Results:subtypes

singleADCMul0-GGO

45.1

28.1

0

00

0

JTO2011

Same

Pan-

Muta0onoccurredin

tumor(73%)

onlyone

+

Differentmuta0ons(12%)

Mul0pleGGOsmayariseasindependentevents

Driver-muta0ondistribu0onin72pa0ents,144GGOs

nega0ve

4%

Discordantrate85%

muta0on

11%

Pan-

nega0ve

4.2%

Same

muta0on

11.1%

Discordantrate

84.7%

Mutationoccurredin

onlyonetumor72.2%

Differentmutations12.5%

Results:survival

Mul0pleGGOsvsIA-SingleADC

RFS:P=0.255

OS:P=0.904

Results: