| Background and ObjectiveThe incidence and mortality of lung cancer ranks the forefront of all kinds of malignant tumors in the world,which seriously threaten human health.The overall incidence rate of multiple primary lung cancers(MPLC)is low in lung cancer,which means two or more primary cancers with different origins in the same patient.But in recent years,with the wide application of multislice spiral computed tomography(CT)and positron emission tomography(PET),and the promotion of treatment,the incidence of MPLC is also increasing.Although many studies have analyzed the clinical characteristics and survival of MPLC,the results are different,and there is no unified standard for diagnosis and treatment of MPLC.Especially when the histologic types of MPLC are the same,it is difficult to distinguish MPLC from intrapulmonary metastasis(IM).This study is aimed at providing a basis for clinical diagnosis and treatment by retrospective analysis of 120 patients with MPLC.MethodsThe clinical data of lung cancer patients who underwent surgery in the First Affiliated Hospital of Zhengzhou University from January 1,2014 to December 31,2019 were collected.According to the diagnostic criteria established by Martini and Melamed in 1975,the patients who met the criteria and had complete clinical data and postoperative follow-up data were selected.The lesion characteristics,pathological results,surgical methods,lung cancer driving gene detection results and survival of these patients were analyzed.RT-PCR/ARMS-PCR or next-generation sequencing technology(NGS)were used for gene detection.The follow-up period was 2021.1.1.Disease free survival(DFS)is the time from the time of operation to the time of disease recurrence,death from any cause or the last follow-up.ResultsThere were 262 lesions in 120 patients with MPLC.The most common lesions were in the upper lobe of the lung,with the right upper lobe accounting for 33.21%(87/262),followed by the right lower lobe(54/262,20.61%).The lesions located in unilateral lobes(83/120,69.17%)were more than those in bilateral lobes(37/120,30.83%).Adenocarcinoma was the most common pathological type(244/262,93.13%),and acinar type was the most common pathological subtype of adenocarcinoma.The number of patients with the same pathological type(105/120,87.50%)was much more than that of patients with different pathological types(15/120,12.50%).Only one case with the same pathological type was squamous cell carcinoma,and the rest were adenocarcinoma.Of the 52 patients with adenocarcinoma,23 had the same subtype and 29 had different subtypes.The most common TNM stage was 0-Ⅰ,accounting for 85.83%(103/120).The main operation method was lobectomy and sublobar resection(62/120,51.67%),followed by sublobar resection and sublobar resection(40/120,33.33%).42.37%(111/262)lesions underwent lung cancer driver gene detection,and the mutation rate was 81.08%(90/111).The mutation rate of L858R in exon 21 of EGFR was 43.33%(39/90),which was the most common mutation type,followed by exon 19 of EGFR(17/90,18.89%).Among the 18 patients with multiple lesions who underwent driver gene detection,10 had different mutation types,and 8 had the same mutation type.The 1-year,3-year,5-year DFS of patients were 94.1%,85.2%,and 62.2%,respectively,and the average DFS was 50.43 months.Univariate survival analysis showed that smoking history(χ2=5.151,P=0.023),lymph node metastasis(χ2=34.588,P<0.001),pleural invasion(χ2=5.405,P=0.020),highest TNM stage Ⅱ-Ⅳ(χ2=38.405,P<0.001),the sum of the maximum diameter of tumor>3cm(χ2=8.793,P=0.003)and different pathological types(χ2=13.736,P<0.001)were the poor prognostic factors of MPLC.Cox multivariate survival analysis showed that pleural invasion(HR=3.894,95%CI:1.071-14.153,P=0.039),highest TNM stageⅡ-Ⅳ(HR=7.383,95%CI:1.176-46.365,P=0.033),the sum of the maximum diameter of tumor>3cm(HR=5.184,95%CI:1.139-23.602,P=0.033)were independent risk factors for DFS in MPLC patients.ConclusionsMost of the pathological types were adenocarcinoma,and acinar type was the most common subtype of adenocarcinoma.The patients with the same pathological type were more common than those with different pathological types.The detection of lung cancer driving genes has a certain value in differentiating primary cancer from metastatic cancer.The patients with smoking history,lymph node metastasis,pleural invasion,relatively late TNM stage,different pathological types,the sum of the maximum diameter of tumor>3cm have relatively poor prognosis.Early diagnosis,active surgical treatment and smoking cessation can improve the prognosis of patients with MPLC. |
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