Clinical Features And Surgical Outcomes Of Synchronous Multiple Primary Non-small Cell Lung Cancers

Objective With the popularity of low-dose CT,the detection rate of synchronous multiple primary lung cancers(sMPLC)is increasing.In order to explore the role of surgery in the treatment and prognosis of sMPLC,we retrospectively analyzed the surgical results of a series of patients with sMPLC.Methods From January 2013 to November 2018,78 patients who met the diagnostic criteria of sMPLC were retrospectively analyzed in the Department of thoracic surgery,Qilu Hospital,Shandong University.All patients underwent R0 resection and lymph node dissection or sampling without any induction therapy before operation.We analyzed the postoperative survival rates and counted the baseline information of patients,such as gender,age,symptom,family history of cancers,tumor markers,tumor laterality,tumor location,tumor number,tumor size,lymph node metastasis,TNM stage,operation mode,operation times,tumor pathology,tumor visceral pleural invasion,postoperative adjuvant therapy and so on.Then,SPSS20.0 was used to further explore the influencing factors of disease free survival(DFS)and overall survival(OS).Results There were 115 patients,with the median age of 62 years old(28-76 years old).Among all the patients,48(61.54%)were female,21(26.92%)had a history of smoking,23(29.49%)had clinical symptoms,4(5.13%)had a family history of malignant tumor and 19(24.36%)had elevated preoperative tumor markers.Among the highest pT staging,64(82.05%)patients were T1(d≤3cm),12(15.38%)patients were T2(3<d≤5cm),and 2(2.56%)patients were T3+4(d>5cm).In N staging,72(92.31%)patients were NO and 6(7.69%)patients were N1+2.In TNM staging,60(76.92%)patients were in stage I,15(19.23%)patients were in stage II and 3(3.85%)patients were in stage III.There were 69(88.46%)patients with tumors located in the same side,52(66.67%)patients with lesions located in different lobes,65(83.33%)patients with double primary lung cancer and 72(92.31%)patients with surgery at the same time.In the choice of surgical methods,32(41.03%)patients underwent lobectomy alone,and 35(44.87%)patients underwent lobectomy plus sub-lobectomy(segmental resection or wedge resection).Adenocarcinoma was the most common pathological type in all of the carcinomas.The 1-,2-,3-,4-and 5-year disease free survival(DFS)rates were 93.42%,86.84%,77.78%,62.96%and 60.00%,respectively.The 1-,2-,3-,4-and 5-year overall survival(OS)rates were 94.73%,92.11%,82.22%,77.78%and 65.00%,respectively.After surgery,the TNM stage was an independent risk factor for DFS,smoking history and the TNM stage were independent risk factors for OS.Conclusion 1.SMPLC was more common in women with better prognosis than pulmonary metastasis.And adenocarcinoma was the most common pathological type in all of the patients.2.Surgery(R0 resection and lymph node dissection or sampling)was an effective treatment for patients with sMPLC if the lung function permits.3.For sMPLC,TNM stage of the largest tumor was an independent risk factor for DFS.Smoking history and TNM stage of the largest tumor were independent risk factors for OS.