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CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.
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Humans , Multiple Pulmonary Nodules/surgery , Lung Neoplasms/surgery , Adenocarcinoma/surgery , Lung/pathology , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE@#To evaluate the effect of transcutaneous acupoint electrical stimulation (TEAS) at Neiguan (PC 6) on general anesthesia under preserving spontaneous breathing in thoracoscopic lobectomy.@*METHODS@#A total of 66 patients of primary lung cancer undergoing thoracoscopic lobectomy were divided to an observation group (33 cases, 1 case discontinued) and a control group (33 cases). In the observation group, TEAS at Neiguan (PC 6) was used 30 min before anesthesia induction till the end of surgery. The surgery time, maximum value of partial pressure of end-tidal carbon dioxide (PETCO2) and minimum value of oxygen saturation (SpO2) of the two groups were recorded. The dosage of propofol, sufentanil, remifentanil and dexmedetomidine were analyzed. Separately, before induction (T0), at the start of surgery (T1), thoracic exploration (T2) and lobectomy (T3), as well as 30 min (T4) and 60 min (T5) after lobectomy, the mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), serum cortisol (Cor) and norepinephrine (NE) were measured. The time of post anesthesia care unit (PACU) stay, ambulation, flatus, chest drainage and the incidence of nausea and vomiting were compared between the two groups.@*RESULTS@#The maximum value of PETCO2, the dosage of propofol and remifentanil in the observation group were lower than those in the control group (P < 0.05, P < 0.01), the minimum value of SpO2 in the observation group was higher than that of the control group (P < 0.01). At T1-T5, the MAP, HR, serum Cor and NE levels in the observation group were all lower than those in the control group (P < 0.05). The ambulation time, the time for the flatus, chest drainage time, and the incidence of nausea and vomiting in the observation group were all lower than those in the control group (P<0.001, P < 0.01).@*CONCLUSION@#For the general anesthesia under preserving spontaneous breathing in thoracoscopic surgery, TEAS at Neiguan (PC 6) relieves stress response, reduces opioids dosage and promotes postoperative recovery.
Subject(s)
Humans , Acupuncture Points , Carbon Dioxide , Flatulence , Propofol , Remifentanil , Anesthesia, General , Nausea , Norepinephrine , Electric StimulationABSTRACT
Minute pulmonary meningothelial-like nodules (MPMNs) are benign small lesions in the lungs, with similar pathological characteristics to the meningeal epithelium. MPMNs have similar imaging manifestations to malignant tumors, which can lead to misdiagnosis in clinical practice. There is no consensus on the pathogenesis of MPMNs, with some suggest that MPMNs derive from reactive proliferation, while others suggest that MPMNs share a common origin and molecular mechanism with meningiomas in the central nervous system. Understanding the characteristics of MPMNs and studying their pathogenesis will help improve the understanding and diagnosis of MPMNs. In this article, we reviewed the clinical, pathological, imaging characteristics, differential diagnosis and pathogenesis of MPMNs. We also analyze the existing research advances regarding the pathogenesis and propose prospects for further research. .
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@#With the changes in the disease spectrum and the advancement of examination technology, the detection rate of multiple primary lung cancers (MPLC) is gradually increasing when multiple nodules and masses in the lung are examined clinically. MPLC has significant distinction with other types of lung diseases or lung cancers in the treatment and prognosis. In most cases, patients would be recommended to undergo the surgery as soon as possible which means that the accurate diagnosis should be made before surgery or during treatment. The newly developed molecular and genomic methods are more likely to better determine the relationship between multiple lesions. Artificial intelligence can be used as a related diagnostic aid to show more accurate and objective results in the diagnosis of multiple pulmonary nodules. This review summarizes the latest MPLC diagnostic research (including pathological analysis, imaging), analyzes surgical treatment methods, and looks forward to the future research direction of MPLC diagnosis and treatment, in order to provide reference for MPLC research.
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@#With the broad application of high-resolution computed tomography (CT) and high rates of early lung cancer screening, the number of patients diagnosed with synchronous multiple primary lung cancer (sMPLC) has been increasing. It becomes of great prominence to distinct sMPLC from intrapulmonary metastases in clinical practice. An increasing number of studies have developed high-throughput sequencing based genetic approaches to specify the molecular characteristics of sMPLC, which contributes to a better understanding of its tumorigenesis. The genetic profile of sMPLC also benefits its diagnosis, which mainly relies on its clinicopathological criteria. Here, we summarize the progresses on the diagnostic criteria for sMPLC, and also molecular features of sMPLC from the perspective of clonality analysis.
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Multiple primary lung cancer (MPLC) refers to lung cancer in which two or more primary lesions occurred simultaneously or successively in different parts of the same patient's lungs. The diagnosis interval is 6 months. MPLC is divided into synchronous MPLC (sMPLC) and metachronous MPLC (mMPLC). sMPLC and intrapulmonary metastasis (IM) are different in treatment strategies and prognosis. However, there are many controversies about the distinction between the two in clinical practice. This article summarizes the current main methods of diagnosing MPLC, and focuses on the latest research progress in distinguishing MPLC from IM. It aims to provide a theoretical basis for accurate diagnosis and treatment of patients with multifocal lung cancer. .
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@#Multiple primary lung cancer is a special type of lung cancer. Its detection rate is increasing year by year, and there is no clear diagnosis and treatment strategy, which makes the diagnosis and treatment become a hotspot in clinical work. The molecular genetics is gradually changing the status quo of relying only on imaging and tumor-free interval to distinguish lung metastasis from multiple primary lung cancer, and it is an effective method for differential diagnosis and prediction of biological behavior of lung cancer. Based on our experience and other studies, it is recommended that surgical treatment should be preferred when there is no contraindication. The advantages and disadvantages of bilateral thoracoscopic surgery for bilateral multiple primary lung cancer during the same period are discussed, and its feasibility and safety are confirmed. For the lesions that cannot be completely resected, active surgical local treatment is recommended. The diagnosis and treatment of multiple primary lung cancer is still a clinical difficulty, and we hope that our research can provide theoretical and practical guidance for clinicians.
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@#Objective To explore the value of artificial intelligence (AI) diagnostic imaging system and three dimensional computed tomographic bronchoangiography (3D-CTBA) surgical planning system in the management of multiple primary lung cancer (MPLC). Methods The clinical data of 53 patients with MPLC treated surgically in our hospital from January 2018 to August 2020 were retrospectively analyzed, including 16 males and 37 females, with a median age of 60 (39-75) years. The patients' preoperative CT was analyzed by AI and manually, and the data of patients who underwent 3D-CTBA were compiled to evaluate the value of AI and 3D-CTBA in the diagnosis and treatment of MPLC, respectively. Results The sensitivity of AI screening for MPLC was 84.91%. The sensitivity (91.90% vs. 83.78%) and accuracy (85.60% vs. 84.00%) of AI diagnosis of high-risk MPLC infiltrative lesions were better than those of manual diagnosis. 3D-CTBA was used for planning the surgery in 12 patients, and the intraoperative situation was generally consistent with the reconstructed results. Conclusion AI is of high value in identifying infiltrative lesions of MPLC. 3D-CTBA reconstruction of anatomical structures is accurate and can guide preoperative planning.
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Objective To analyze the CT features of solitary pulmonary nodules(SPN) in patients with malignant tumor with the aim of improving its diagnosis and differential diagnosis in this special background .Methods From May 2014 to De-cember 2018, the CT data of 76 pathologically confirmed SPNs in patients with malignant tumor were retrospectively analyzed . The CT features of SPNs, including density, morphology and change of peripheral lung field and adjacent structures, were mainly analyzed.The characteristics of different types of nodules and their differences were summarized .Results Among the 76 SPNs, there were 41(53.9％) primary lung cancers, 14(18.5％) metastatic tumors, and 21(27.6％) benign lesions(in-cluding 12 inflammatory nodules, 7 tuberculous nodules and 2 benign tumors).Of all nodules, there were 57(75％) solid nodules, including 23(40.4％) primary lung cancers which mainly manifested as nodules with rough margin , close to adjacent vessel and bronchus and usually had internal or edge features(19, 82.6％), 14(24.6％) metastatic tumors which mainly showed as round or oval, homogeneous density, smooth margin nodules(12, 85.7％), and 18(31.6％) inflammatory nodules which mainly showed as lesions with rough and blurred margin accompanied by peripheral patch or fibrosis (14, 77.8％). There were 19(25％) sub-solid nodules, including 18(94.7％) primary lung cancers, which mainly manifested as nodules with heterogeneous density and clear border(14, 77.8％).There was only 1(5.3％) sub-solid inflammatory nodule.Conclu-sion The pathological nature of SPNs in patients with malignant tumors is various .Understanding their CT characteristics is helpful for diagnosing and differentiating and providing useful information for further treatment .
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Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs) on computed tomography (CT) image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS). .
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Humans , Adenocarcinoma , Diagnostic Imaging , Genetics , Pathology , Adenocarcinoma of Lung , Lung Neoplasms , Diagnostic Imaging , Genetics , Pathology , Retrospective Studies , Solitary Pulmonary Nodule , Diagnostic Imaging , Genetics , Pathology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND@#Simultaneity multiple primary lung cancer always is a rare disease, but in recent years due to the progress of the diagnosis and treatment means detection rate increased. This study summarized the clinical data of 31 cases of synchronous multiple primary lung cancer (sMPLC) analysis, further to explore the diagnosis, treatment and prognosis of MPLC.@*METHODS@#Sum up the clinical data of 31 cases of simultaneous multiple primary lung cancer, the diagnostic method, surgical methods, pathology, were retrospectively analyzed.@*RESULTS@#All the patients are thoracoscope surgery, no deaths. Thin high resolution computed tomography (CT) in preoperative found multiple lung nodules. Lesions located in the same side of the same period surgical treatment, the operation method is given priority to with under the thoracoscope lung + the lobectomy; Lesions located in bilateral, all staged operation, the time interval for 3 months-4 months.@*CONCLUSIONS@#Thin layer distinguish CT preoperative diagnosis is the best way to simultaneous multiple primary lung cancer. Multiple primary lung cancer incidence of ipsilateral lung at the same time higher than that of bilateral lung (23:8), type, around 94%, the most common histology to adenocarcinoma, 80.6% (25/31). Primary lesions under thoracoscope lobectomy plus the lobectomy of secondary lesions is the most commonly used.
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Adult , Aged , Female , Humans , Male , Middle Aged , Lung Neoplasms , Diagnosis , Diagnostic Imaging , General Surgery , Neoplasms, Multiple Primary , Diagnosis , Diagnostic Imaging , General Surgery , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Objective To analyse the value of serum alpha fetoprotein(AFP),keratin antigen 21-1(CY-FRA21-1)and neuron specific enolase(NSE)in the diagnosis and prognosis of lung cancer.Methods A total of 89 patients with primary lung cancer were selected as the primary lung cancer group from June 2014 to June 2016.The other 59 cases of benign lung disease were selected as the benign lung disease group,and 63 cases of healthy physical examination were collected as normal group.The content of AFP,CYFRA21-1 and NSE were detected by electrochemiluminescence assay.Results Before treatment,the levels of AFP,CYFRA21-1 and NSE in the benign lung disease group and the primary lung cancer group were significantly higher than those in the normal group,those in the primary lung cancer group were significantly higher than those in the benign lung disease group(P<0.05).The levels of AFP,CYFRA21-1 and NSE in patients with stage Ⅲ aand Ⅲ b-Ⅳ were significantly higher than those in patients with stage Ⅰ - Ⅱ,and those in Ⅲ b- Ⅳ stage were signifi-cantly higher than those in Ⅲ astage(P<0.05).The sensitivity,specificity,accuracy of two joint tests were significantly higher than those of the single test,those of the three joint tests were significantly higher than those of the single test and the two combined tests,and the differences were statistically significant(P<0.05).The AFP,CYFRA21-1 and NSE of the patients in the ineffective group were significantly higher than those in the effective group,and the differences were statistically significant(P<0.05).Conclusion Tumor markers AFP,YFRA21-1 and NSE are of great value in the diagnosis and treatment of lung cancer,joint detec-tion could improve the positive rate and accuracy of diagnosis.
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Objective To invesitigate the application of contrast enhanced ultrasound in differentiating focal organizing pneumonia( FOP) and primary lung cancer . Methods The imaging data of 23 cases with FOP ( FOP group) and 75 cases with primary lung cancer ( primary lung cancer group) on conventional ultrasound and contrast enhanced ultrasound were retrospectively analyzed . The size and arrival time( AT) of the contrast agent and the enhanced pattern of the two groups were compared . ROC curve was created to determine the most accurate AT for differential diagnosis . Results There was no significant difference in the gender and the size of nodule between the two groups ( P > 0 .05) . The age of FOP group was younger than that of primary lung cancer group ( P = 0 .013) . The AT of FOP group was much earlier than that of primary lung cancer group [ ( 6 .9 ± 2 .4) s vs ( 11 .4 ± 4 .3) s , P = 0 .000] . In FOP group ,20 patients ( 87 .0％ ) showed centrifugal enhancement , 2 patients ( 8 . 7％ ) showed centripetal enhancement and 1 patient ( 4 .3％ ) showed diffuse homogeneous enhancement ,respectively .In primary lung cancer group , 12 patients ( 16 .0％ ) showed centrifugal enhancement , 58 patients ( 77 .3％ ) showed centripetal enhancement ,2 patients ( 2 .7％ ) showed diffuse homogeneous enhancement and 3 patients ( 4 .0％ ) showed diffuse heterogeneous enhancement ,respectively . There was significant difference in the enhanced pattern between the two groups ( P = 0 .000) . Meanwhile ,8 patients in FOP group ( 34 .8％ ) and 31 patients in primary lung cancer group ( 41 .3％ ) had unenhanced region in the nodule ( P = 0 .574) . ROC analysis demonstrated that AT of 8 .5 s was the best cut-off value for the differential diagnosis . When AT earlier than 8 .5 was taken as diagnostic criterion for FOP ,the diagnositc sensitivity ,specificity were 74 .7％and 82 .6％ ,respectively . Conclusions Contrast-enhanced ultrasound can provide evidence in differentiating FOP from primary lung cancer .
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Clinical trials play an important role in guiding clinical practice .Over the past decade , Chinese investigators on lung cancer have not only participated and gradually taken a leadership in international multi -center clinical trials , but also established the first multi-center collaborative clinical trial group in China , which has promoted the development of new anti-cancer drugs , the for-mation of new treatment strategies and the innovation of clinical trial designs .Taking epidermal growth factor receptor-tyrosine kinase inhibitors, we focus on the clinical trials on lung cancer aimed at reshaping the clinical practice strategies in China or even worldwide with the participation or leadership of Chinese researchers as well as current challenges and future prospects in lung cancer studies .
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Objective Toexplore expression and clinical significance of WWOX protein and the Bcl-2 protein in the organiza-tion of bronchial lung cancer (primary lung cancer).Methods Chose 76 lung cancer patients with clear pathological diagno-sis who were hospitalized in the Shaanxi Provincial People’s Hospital from 2010 and 2015(including 29 cases of adenocarci-noma,27 cases of squamous cell carcinoma,and 20 cases of small cell carcinoma)and 7 cases of normal lung tissue,8 cases of lung tuberculosis.The expressions of WWOX protein,Bcl-2 protein and more that 5 cm normal lung tissue adjacent to carci-noma were measured by immunohistochemistry SP method.The expression difference between patients and normal control group and the influence of sex,age,pathological type,differentiation degree,clinical stage,lymph node metastasis,smoking index on the expression of WWOX protein and Bcl-2 protein in lung cancer were analyzed.Results ①The positive expres-sion rate of WWOX protein in lung cancer group (35.52%)was significantly lower than that in normal lung tissue (73.33%,P<0.05).The positive expression rate of Bcl-2 protein in lung cancer group (78.06%)was significantly higher than that in control group (23.75%,P<0.05 ).②The positive expression rate of WWOX protein in male patients (21.43%)was significantly lower than that in female patients (52.94%),and the difference was statistically significant (χ2=8.146,P=0.04).The positive expression rate of Bcl-2 protein in male patients (71.43%)was significantly higher than that in female patients (35.29%),the difference was statistically significant (χ2=9.923,P=0.002).③In lung cancer with lymph node metastasis,the positive rate of WWOX protein (17.07%)was significantly lower than that in non-lymph node metastasis (48.57%),and the difference was statistically significant (χ2=8.67,P=0.003).In lung cancer with lymph node metastasis,the positive rate of Bcl-2 protein expression (68.29%)was significantly higher than that in non-lymph node me-tastasis (34.28%),and the difference was statistically significant (χ2=8.758,P=0.003).④The positive rate of expression of WWOX protein in patients whose smoking index≥400 and in patients that<400 was 15.63% and 47.73%,respectively, the differences were significant (χ2=8.48,P=0.003).The positive rate of expression of Bcl-2 protein in patients whose smoking index≥400 and in patients that<400 was 56.25% and 22.73%,respectively,the differences were significant (χ2=8.947,P=0.003).⑤WWOX and Bcl-2 protein expressions had no obvious relationship with ages,pathological type,degree of differentiation and clinical stage.⑥WWOX protein expression had negative correlation with Bcl-2 protein expression in lung cancr tissues.Conclusion WWOX protein expression in lung cancer was lower than that in adjacent normal lung tis-sue,Bcl-2 protein expression in lung cancer tissues was higher than that in adjacent normal lung tissue.WWOX protein ex-pression had negative correlation with Bcl-2 protein expression in lung cancer tissues.
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Objective To explore CT manifestion of multiple primary lung cancer (MPLC)and to improve the recognization of MPLC.Methods The CT manifestions of 12 cases with MPLC proved by pathology were retrospectively reviewed.Results All the 12 cases were double primary lung cancer.There were 24 lesions with 21 peripheral and 3 central,the average diameter was (2.2 ± 0.6)cm.Lesions located in contralateral lobes were in 2 patients,and located in ipsilateral lobes were in 10 patients,with 3 located in the same lobe and 7 in the different lobes.There were 7 cases of adenocarcinoma-adenocarcinoma,3 cases of squamous cell carci-noma-adenocarcinoma,1 case of squamous cell carcinoma-squamous cell carcinoma and 1 case of squamous cell carcinoma-carcinoid. 1 1 cases were metachronous and 1 case was synchronous.3 lesions were lump located at hilus of the lung,21 lesions were intrapul-monary nodules,showing masses with lobulated shape,spicules of margin,vascular convergence,vacuole and pleural indentation sign.Most foci displayed moderate intensity enhancement and homogeneous density in triphase enhanced scans,the CT value of le-sions on enhanced images ranged from 20-60 HU.Conclusion MPLC are synchronous and peripheral adenocarcinoma type,all of the lesions have typical CT features of primary lung cancer.
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Objective:Previous studies suggested that the-308G/A allele in the tumor necrosis factor-α(TNF-α) gene promoter (-308G/A) may be a potential risk factor for inflammatory diseases and tumor progression. However, only a few studies have focused on the-308 polymorphism of TNF-αgene with primary lung cancer in Chinese population. This study aims to evaluate the role of TNF-α-308G/A single nucleotide polymorphism (SNP) and the risk of primary lung cancer in Chinese population. Methods:A total of 250 patients and 447 healthy individuals (control group) were involved in this study. Genotyping was performed using TaqMan technology. Results:The frequencies of (GG), (A/G), and (A/G+AA) genotypes of-308G/A SNP in TNF-αgene were 183 (73.2%), 67 (26.8%), and 67 (26.8%) in the patients, and 406 (90.8%), 39 (8.7%), and 41 (9.2%) in the control group, respectively. The distribution of poly-morphism frequencies in the case group and the control group showed a statistically significant difference for the Chinese population (P<0.05). Conclusion:Results indicated that TNF-αgene polymorphism at position-308G/A is associated with susceptibility to lung cancer in Chinese Han population.
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This article was aimed to study the relevance on traditional Chinese medicine (TCM) syndromes and TNM staging and tumor antigen in primary lung cancer, in order to provide theoretical supports for TCM prevention and treatment as well as medication guidance of primary lung cancer. Statistical data from 388 lung cancer patients were analyzed according to the relevance TCM syndromes, in order to find the relation between syndrome distribution of lung cancer and TNM staging and tumor antigens. The results showed that in TNM staging, the incidence of lung-yin deficiency syndrome in I stage was apparently higher than that in IV stage; the incidence of spleen-qi deficiency syndrome in IV stage was apparently higher than that in I stage; and there was no obvious difference in lung-qi deficiency syndrome, stasis obstructing lung collateral syndrome or lung-yin deficiency with fire-excess. The proportion of CEA in lung-yin deficiency with fire-excess syndrome was significantly higher than that in lung-yin deficiency syndrome, lung-qi deficiency syndrome, and stasis obstructing lung collateral syndrome. The proportion of abnormal increasing of NSE in lung-yin deficiency with fire-excess syndrome was significantly higher than other syndromes. The proportion of abnormal increasing of CYFRA21-1 in lung-yin deficiency with fire-excess syndrome and stasis obstructing lung collateral syndrome was significantly higher than that in lung-qi deficiency syndrome. It was concluded that there were certain relevance between TCM syndromes and TNM staging in lung cancer. Lung-yin deficiency syndrome, which existed in all stages of lung cancer, was the most obvious in the early stage. Spleen-qi deficiency syndrome was commonly seen in the advanced stage of lung cancer. There were certain relevance between different TCM syndromes and the abnormal increasing of tumor antigens including CEA, NSE and CYFRA21-1.
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This article was aimed to study the relevance between traditional Chinese medicine ( TCM ) syndromes and the treatment of chemotherapy and targeted therapy , in order to provide theoretical support for TCM syndromes of lung cancer in the clinical application . Uniform TCM syndromes questionnaire was used in the TCM syndrome differentiation among lung cancer patients from the Oncology Department of Longhua Hospital, Shanghai University of Traditional Chinese Medicine and TCM Department of Shanghai Pulmonary Hospital. The analysis was made on correlation between distribution rules of TCM syndromes and chemotherapy and targeted therapy . The results showed that among primary lung cancer patients , the most TCM syndromes were syndrome of lung-yin deficiency , lung-q i deficiency , blood stasis in lung collaterals , spleen-q i deficiency , lung-yin deficiency with fire excess . There were certain correlation in TCM syndromes and different TCM therapeutic methods , in which targeted therapy had great significant effect on syndrome of lung-yin deficiency ( P < 0 . 05 ) , after targeted therapy syndrome of lung-yin deficiency increased obviously . It was concluded that there were some regulations in TCM syndromes of lung cancer which take syndrome of lung-yin deficiency, lung-qi deficiency, blood stasis in lung collaterals, spleen-qi deficiency, lung-yin deficiency with fire excess. There were certain correlation in TCM syndromes and different TCM therapeutic methods , after targeted therapy syndrome of lung-yin deficiency increased obviously .
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Background and purpose:Multiple primary lung cancers (MPLC) is a rare entity, but recently there has been a gradual increase in the number of patients diagnosed with MPLC. The aim of this study is to investigate the diagnosis, treatment and prognosis of MPLC through analyzing the clinical data.Methods:Forty-one patients were diagnosed MPLC by Martini-Melamed criteria. Their clinicopathological data were retrospectively reviewed. Results:There were 3 patients with triple primary lung cancer and 38 patients with double primary lung cancer. There were 13 patients with synchronous MPLC, 26 patients with metachronous MPLC, 2 patients with synchronous and metachronous MPLC. Of 85 lesions, the surgical procedures were mainly lobectomy (78.8%, 67/85). Lesions (41.2%, 35/85) were frequently in right upper lobe. Pathological type was mainly adenocarcinoma (70.6%, 60/85),followed by squamous cell carcinoma (17.6%, 15/85). Of 60 adenocarcinoma specimens, the papillary predominant subtype was more common (50%, 30/60). Eighty percent (68/85) of the lesions were stage I. As to the initial cancer and repeated cancer, patients who shared the same pathological type (68.3%, 28/41) were more than the different (31.7%, 13/41), of which adenocarcinoma-adenocarcinoma was most common(82.1%, 23/28). Lesions located in contralateral lobes were in 37 patients (90.2%), and located in ipsilateral different lobes were in 4 patients (9.8%). The 2-year overall survival (OS) of them was 87.8%. Survival analysis showed that the prognosis of patients with same pathological type was better than patients with different pathological type (P=0.037), the prognosis of patients with no lymph node metastasis was better than patients with N1,N2 metastasis (P=0.02).Conclusion:Lesions in patients with multiple primary lung cancers are more frequently in the right upper lobes. The pathology type is mainly adenocarcinoma, of which the papillary predominant subtype was most common. Early diagnosis improves continuously, active treatment with operation can achieve better prognosis.