Background: With the popularization of high-resolution computed tomography (HRCT), there is a rising trend of the detection of multiple primary lung cancers (MPLC). Adenocarcinomas is the major pathological type of MPLC. At present, reports on MPLC are relatively common, but few study focused on synchronous multiple primary lung adenocarcinomas (SMPLA). We carried out this study in an attempt to enhance our understanding about SMPLA.
Methods: Data from 38 patients undergoing surgery for SMPLA in our institution frrom December 2012 and July 2016 were retrospectively collected.
Results: Among the 38 patients, 12 patients were male, 26 patients were female, with a median age of 58 (ranging from 39 to 73). Surgical outcomes verified 29 patients with 2 tumors and 9 patients with more than 2 tumors. There were 26 patients with tumors in ipsilateral lung while 12 patients in contralateral lung. Eight patients underwent one-stage surgical treatment for contralateral tumors with mean postoperative hospitalization of 10 days. The gene detection results of 5 patients showed different epidermal growth factor receptor (EGFR) mutations can be found in one patient's different tumors. The 1-year and 3-year overall survival (OS) rate were 96.6% and 74.2%. Larger maximal tumor dimension (P<0.001), advanced pT stage (P=0.003), lymph nodes metastases positive (P=0.001), advanced TNM stage (P=0.022) and postoperative adjuvant chemoradiotherapy (P=0.009) were correlated with poor OS.
Conclusions: Multiple lung malignant lesions should not be taken as metastasis for granted and the possibility of MPLC also should be considered. Mutational status of EGFR could be used as a clinical reference to diagnose patients with SMPLA.
背景与目的 随着高分辨率计算机断层扫描（high-resolution computed tomography, HRCT）应用的普及，多原发肺癌（multiple primary lung cancers, MPLC）的检出率逐年上升，其中腺癌是最常见的病理类型。目前国内外对MPLC的研究已相对多见，但罕有单独分析同时性多原发肺腺癌（synchronous multiple primary lung adenocarcinomas, SMPLA）的报道。本研究探讨SMPLA患者的临床病理特点及预后，旨在提高对SMPLA的认识。方法 对2012年12月-2016年7月期间我科38例临床资料保存完整的SMPLA患者进行了回顾性分析。结果 38例SMPLA患者中，男性12例，女性26例，中位年龄为58岁（39岁-73岁）。双原发肺腺癌29例，2个病灶以上9例。病灶位于同侧26例，双侧12例。同期手术34例（包括8例患者同期行双侧手术），分期手术4例。5例患者对每个病灶分别行基因检测，结果证实不同病灶的表皮生长因子受体（epidermal growth factor receptor, EGFR）基因突变类型不完全相同。1年和3年总生存率分别为96.6%和74.2%。肿瘤直径越大（P<0.001）、T分期越高（P=0.003）、淋巴结转移（P=0.001）、TNM分期越高（P=0.022）以及术后放、化疗（P=0.009）提示总生存预后较差。结论 对于多发的非小细胞肺癌，不能轻易地诊断为转移癌，应考虑多原发可能。EGFR基因检测可作为鉴别多原发肺腺癌与复发转移癌的临床参考。.