Artikel
Das synchrone Doppelkarzinom der Lunge: Diagnose, Therapie und Prognose
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Veröffentlicht: | 2. Mai 2006 |
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Gliederung
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Einleitung: Second, third or multiple NSCLC are rare, particularily appearing synchronously. According to UICC-Classification 1999, they have to be differentiated from satellites (T4) and metastases (M1). Aim of this prospective cohort study was to determine if synchronous second primaries (SSP) are a tumor class of their own.
Material und Methoden: In 1950 patients operated on for the diagnosis of NSCLC between 2001 and 9/2005, 86 patients showed multiple tumor growth (at least 2 focusses), 4 patients showed 3, 5 patients multiple focusses. In 46 patients the additional tumors were classified as satellite same lobe (T4) or satellite other lobe (M1). 32 carcinomas showed to be a SSP characterized by histologic typing, position related to the great vessels or N0-Staging. 8 patients were operated on for metachronous second primaries (MSP) during this observation period.
Ergebnisse: 40 operations for SSP were performed in 32 patients, 8 patients had to be operated twice because of bilateral tumor site. Median patients’ age was 71,4 yrs. Operations performed were: 20 lobectomies, 4 bilobectomies, 2 pneumectomies and 22 wedge or segmental resections. There was no perioperative mortality. One patient died 31 days after the second operation in septic shock syndrome. Five patients died because of tumor recurrence, one local recurrence after R1-resection (ext. pneumonectomy). Tumor 5yrs. Survival was overall 81,3% with 50% in mediastinal LN involvement and 95% in N0. 3 more patients diesd by other reasons. Median observation period is 34.7 (+/- 25.4) months, ending up 9/05. One patient showed a metachronous third primary during observation period and left study by month 39.
Schlussfolgerung: Although patients with SSP are older and show higher comorbidity, operation should be therapy of choice because of the good prognosis. Adjuvant therapies seem not to be tolerated well particularily after a second operation in double sided tumors. Limited resections seem to have a higher impact in this group of patients.