328.2 🩺 國考版

328.2.1 高頻考點

328.2.1.1 Most Common Primary Tumors with Lung Mets

  • Breast (50-60%)
  • Colorectal (30-40%)
  • Melanoma (50-70%)
  • Sarcoma (high rate)
  • Renal cell
  • Testicular (germ cell)
  • Head and neck

328.2.1.2 Patterns

  • Multiple bilateral peripheral nodules (most)
  • Miliary: thyroid (papillary), renal, melanoma, sarcoma
  • Lymphangitic: breast, GI, prostate; poor prognosis
  • Endobronchial: renal, colon, breast
  • Cavitating: squamous, sarcoma

328.2.1.3 Metastasectomy Criteria

  • Primary controlled
  • No extrapulmonary mets (or controlled)
  • All resectable
  • Adequate pulmonary reserve
  • Long disease-free interval often

328.2.1.4 Outcomes by Primary

  • Colorectal: 30-50% 5-yr
  • Sarcoma: 25-40% 5-yr
  • Renal cell: 30-40% 5-yr
  • Melanoma: less benefit
  • Germ cell: high cure

328.2.1.5 Trials

  • PulMiCC (2020): questioned metastasectomy benefit (controversial)
  • SABR-COMET (2019): SABR for oligometastatic ↑ OS

328.2.1.6 Oligometastatic Disease

  • 1-5 mets (definition varies)
  • Aggressive local therapy may ↑ OS

328.2.1.7 SABR + RFA

  • For non-surgical candidates
  • Limited number of mets
  • Comparable outcomes

328.2.1.8 Lymphangitic Carcinomatosis

  • Rapid progressive dyspnea
  • HRCT: linear/reticular + septal thickening
  • Poor prognosis
  • Treat primary

328.2.1.9 Paraneoplastic Pulmonary

  • HPOA: adenocarcinoma → clubbing + periostitis
  • Tumor embolism: choriocarcinoma; rare
  • Trousseau: hypercoagulability
  • DIC: APML, various

328.2.2 易混淆比范

Pattern Common Primaries Treatment
Multiple nodules Breast, colon, kidney Systemic + metastasectomy if select
Miliary Thyroid (papillary), renal, melanoma, sarcoma Systemic
Lymphangitic Breast, GI, prostate Systemic; poor prognosis
Endobronchial Renal, colon, breast Bronchoscopic + systemic
Pleural Lung, breast, ovary, lymphoma Pleurodesis or PleurX + systemic
Cavitating Squamous, sarcoma, colon Systemic

328.2.3 Special Topics

328.2.3.1 Differentiating Primary vs Metastatic

  • History of prior malignancy
  • Multiple lesions favor mets
  • Solitary metastasis hard to distinguish
  • Tissue biopsy + IHC + molecular
  • PET-CT for whole-body assessment

328.2.3.2 Pulmonary Metastasis in Specific Cancers

Colon Cancer: - Often resectable; SOC + chemo - 30-50% 5-year post-resection

Breast Cancer: - Subtype-driven therapy - Less commonly resected (systemic effective)

Sarcoma: - Pulmonary metastasis common (50%+) - Surgical metastasectomy standard - 25-40% 5-year survival

Testicular: - Highly chemo-sensitive - Residual after chemo: surgical resection of residual masses - Excellent cure rates