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0 2 3年7月第2 6卷第7期 Chin J Lung Cancer, July 2 0 2 3 , Vol. 2 6 , No. 7  ·545 ·  \nDOI: 10.3779/j.issn.1009-3419.2023.101.20 ·病例报道 ·  \n原发性肺癌术后继发或第二原发  \n气管内肿瘤：系列病例报道及文献综述  \n黄唯 谭佩欣 徐中标  \n【摘要】 背景与目的 原发性肺癌根治术后出现继发或第二原发气管内肿瘤患者的临床特征、治疗手段及疗效、预后尚不清楚。本文将通过归纳总结相关病例，对以上问题进行详细阐述。方法 搜索广东省人民医院病历，筛选出5例肺癌术后出现气管肿物的患者，同时搜索PubMed从其他文献中筛选出9例病例。结果 本单位的5例患者中4例的气管内肿瘤被认为是继发于肺癌。在治疗方面，对这5例患者的气管内肿瘤分别进行了根治性切除术（n=2）、同步放化疗（ concurrent chemoradiotherapy, CCRT）（n=1）、化疗（n=1）和姑息治疗（n=1）。接受CCRT 治疗的患者获得最长的无进展生存期，为29.5个月。对于从其他文献中筛选到的9例患者，其中8例患者的气管内肿瘤被定义为转移。这9例患者的10个气管肿瘤分别进行了单独放疗（n=4）、 CCRT（n=2）、单独化疗（n=2）和手术（n=2）。其中，1例单独接受放疗及1例接受CCRT的患者气管病灶均获得了完全缓解。结论 肺癌术后的患者出现气管内肿物应需引起足够重视。 CCRT是原发性肺癌术后气管内新发肿瘤的有效治疗手段。  \n【关键词】 肺肿瘤；继发性气管内肿瘤；第二原发性气管肿瘤；气管转移；气管癌；放疗；化疗  \nSecondary or Second Primary Endotracheal Cancer after Surgery for Primary Lung Cancer:  \nCase Series and Review of the Literature  \nWei HUANG, Peixin TAN, ZhongbiaoXU  \nDepartment of Radiation Oncology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China  \nCorresponding author: ZhongbiaoXU, [E-mail: xzbiao19890507@126.com](E-mail: xzbiao19890507@126.com)  \n【Abstract】 Background and objective The clinical feature, treatment and outcomes of the patients with endotracheal cancer after radical surgery for primary lung cancer are unclear. This article will provide a detailed explanation of the above issues by summarizing the relevant cases. Methods We retrospectively reviewed five patients in Guangdong Provincial People’s Hospital and retrieved 9 cases from other literatures by searching PubMed. Results For five patients in out institute, 4 endotracheal cancers were considered as secondary to lung cancers. Radical stump resection (n=2), concurrent chemoradiotherapy (CCRT) (n=1), chemotherapy (n=1) and palliative care (n=1) were performed separately in 5 patients. The patient underwent CCRT achieved the longest progression-free survival of 29.5 months. For 9 patients retrieved from other studies, 8 endotracheal cancers were defined as metastases. Radiotherapy alone (n=4), CCRT (n=2), chemotherapy alone (n=2) or surgery (n=2) were performed separately in 10 lesions of 9 patients. 1 patient with radiotherapy alone and 1 patient with CCRT achieved complete response. Conclusion More attention should be paid to the abnormality of the trachea after surgery of lung cancer. CCRT maybe a good choice for endotracheal cancers after primary lung cancer.  \n【Keywords】 Lung neoplasms; Secondary endotracheal cancer; Second primary endotracheal cancer; Tracheal metastasis; Tracheal cancer; Radiotherapy; Chemotherapy  \n【Copyright statement】 Copyright © 2023, Chinese Journal of Lung Cancer.  \nThis paper was supported by the grants from National Natural Science Foundation of China (to Zhongbiao XU, No.62101144; to Peixin TAN, No.82203963) and GDPH Supporting Fund for NSFC Program (to Zhongbiao XU, No.6210010230; to Peixin TAN, No. 8210120361).  \n本文受国家自然科学基金（No.62101144、No. 82203963）和广东省人民医院国家自然科学基金启动经费（No.6210010230、No. 8210120361）资助  \n作者单位：510080广州，南方医科大学附属广东省人民医院（广东省医学科学院）放疗科（通信作者：徐中标，E-mail: xzbiao19890507@126 . com）  \n·546 · 中国肺癌杂志2 0 2 3年7月第2 6卷第7期 Chin J Lung Cancer, July 2 0 2 3 , Vol. 2 6 , No. 7  \n肺癌恶性度高、预后差。早期非小细胞肺癌（nonsmall cell lung cancer, NSCLC）在根治术后的复发转移率依然很高[1]。NSCLC引起的最常见的转移部位是骨骼、脑和肝脏，而气管的转移很少见。原发性肺癌导致气管内转移的发生率尚不明确，仅有一项研究报告[2]称，手术切除后 NSCLC的气管转移总发生率为0 . 4 4%（6/1372）。因此，我们对原发性肺癌导致的气管内转移知之甚少。  \n第二原发性肺癌可以被定义为在不同位置和/或不同时间发展的两种独立的肺肿瘤[3]。因此，在第一原发肺癌根治性治疗后独立发生的气管内癌可以被定义为第二原发肿瘤，即使其组织学类型与原发肺癌相同[4]。但作出这一结论需非常谨慎并有充分的证据，否则会影响对肿瘤的分期及其后续治疗策略的判断。  \n最近，随着免疫治疗和靶向治疗与手术的联合应用，肺癌患者术后的生存期显著延长，气管内转移或继肺癌根治术后第二原发气管肿瘤越来越受到关注。然而，其治疗手段、疗效以及生存结局仍不明确。因此，我们报道了广东省人民医院原发性肺癌术后出现继发性或第二原发性气管内肿瘤患者的诊断和治疗方面的经验。此外，我们还回顾了相关文献，共同分析了本院及文献报道中患者的临床特征及相关治疗信息。  \n1 资料与方法  \n我们筛选了本院1991年1月至2019年12月诊断为原发性肺癌后出现气管内肿瘤的患者共12例。12例患者都在本院或院外接受了初始肺癌的手术治疗。其中，7例患者的诊断或治疗相关细节在病历系统中记录不清晰。因此，我们最终纳入了5例医疗记录和随访完整的病例进行分析。  \n所有原发性肺癌和气管内肿瘤的组织切片都经过一名具有20年工作经验的病理学主任医师仔细审阅并作出诊断。气管转移的诊断依据为气管病变与先前原发肺癌之间的病理组织学诊断相同。气管第二原发肿瘤","cbCaic9zdkoJLani","https://ap.wps.com/l/cbCaic9zdkoJLani","pdf",22627457,"Chinese","en","# 资料与方法\n## 患者筛选与纳入标准\n## 病理学诊断与影像学复阅\n## 随访与终点\n# 结果\n## 临床特征\n## 发生间隔与影像学表现\n## 治疗方式与结局","[{\"question\":\"研究纳入了哪些类型的患者？\",\"answer\":\"纳入1991年1月至2019年12月诊断为原发性肺癌后出现气管内肿瘤的患者；最终形成5例医疗记录和随访完整的病例，并补充了PubMed检索到的9例相关病例。\"},{\"question\":\"如何区分气管转移与第二原发气管肿瘤？\",\"answer\":\"气管转移依据气管病变与既往原发肺癌的病理组织学一致；第二原发肿瘤依据气管原位癌或与原发肺癌不同的组织病理学诊断。\"},{\"question\":\"主要治疗方式有哪些，疗效如何？\",\"answer\":\"本院5例气管内肿瘤分别接受根治性切除、同步放化疗(CCRT)、化疗或姑息治疗；接受CCRT者获得最长无进展生存期29.5个月。文献中10个气管肿瘤的治疗包括单独放疗、CCRT、单独化疗与手术，部分放疗或CCRT病灶可达完全缓解。\"}]","原发性肺癌术后继发或第二原发气管内肿瘤：系列病例报道及文献综述 | PDF",1790228928]