肺部是最常見的乳腺癌轉(zhuǎn)移部位之一，但是手術(shù)對于乳腺癌患者孤立惡性肺部結(jié)節(jié)的作用尚不明確。

　　2017年8月28日，美國乳腺外科醫(yī)師學會、外科腫瘤學會《外科腫瘤學年鑒》在線發(fā)表復旦大學附屬腫瘤醫(yī)院和上海醫(yī)學院的研究報告，探討了乳腺癌患者孤立惡性肺部結(jié)節(jié)的手術(shù)結(jié)局。

　　本研究回顧了2007年1月～2014年12月連續(xù)1286例復旦大學附屬腫瘤醫(yī)院胸部CT或PET/CT掃描檢出肺部結(jié)節(jié)的乳腺癌患者，其中147例孤立惡性肺部結(jié)節(jié)接受手術(shù)和/或化療。將患者分為3組：接受手術(shù)的原發(fā)性肺癌患者、接受手術(shù)的肺轉(zhuǎn)移患者、接受化療的肺轉(zhuǎn)移患者。對所有3組患者進行生存結(jié)局分析，包括總生存、無進展生存，并評估肺轉(zhuǎn)移患者無進展生存的預(yù)后因素。

　　結(jié)果發(fā)現(xiàn)：

• 接受手術(shù)的原發(fā)性肺癌患者與肺轉(zhuǎn)移患者相比，總生存和無進展生存顯著較好。

• 接受與未接受轉(zhuǎn)移切除術(shù)的孤立肺轉(zhuǎn)移乳腺癌患者相比，無進展生存顯著較好，總生存未見統(tǒng)計學顯著差異。

• 根據(jù)多變量分析，對于孤立肺轉(zhuǎn)移乳腺癌患者，手術(shù)是無進展生存較好的獨立因素。

　　因此，手術(shù)應(yīng)被作為乳腺癌患者孤立惡性肺部結(jié)節(jié)診斷和治療的有效選擇。

Ann Surg Oncol. 2017 Aug 28. [Epub ahead of print]

Surgical Outcomes of Isolated Malignant Pulmonary Nodules in Patients with a History of Breast Cancer.

Song Z, Ye T, Ma L, Xiang J, Chen H.

Department of Thoracic Surgery, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

BACKGROUND: The role of surgery for isolated malignant pulmonary nodules in breast cancer patients remains unclear.

METHODS: A total of 1286 consecutive breast cancer patients with pulmonary nodules detected by thoracic computed tomography (CT) or positron emission tomography (PET)/CT scan at Shanghai Cancer Center, Fudan University, were reviewed. Overall, 147 breast cancer patients with isolated malignant pulmonary nodules receiving surgery and/or chemotherapy were enrolled in the study. Patients were classified into three groups: patients with primary lung cancer (PLC) receiving surgery (Group 1), patients with lung metastasis receiving surgery (Group 2), and patients with lung metastasis receiving chemotherapy (Group 3). Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were analyzed for patients in all three groups, and prognostic factors for PFS for patients with pulmonary metastasis were evaluated.

RESULTS: Patients with PLC receiving surgery had better survival outcomes, including OS and PFS, than patients with lung metastases who received surgical resection. Breast cancer patients with solitary lung metastasis who received metastasectomy had a significantly better PFS than those who did not; however, no statistically significant difference in OS was observed between the two groups. A multivariate analysis conducted in patients with isolated metastatic breast cancer showed that surgery was an independent factor for better PFS.

CONCLUSIONS: Surgery should be considered a valid option for the diagnosis and treatment of breast cancer patients presenting with isolated malignant lung nodules.

PMID: 28849376

DOI: 10.1245/s10434-017-6067-0