Surgical Treatment Of Multiple Primary Lung Cancer(With 21 Cases’ Reports)

Background and objective: Multiple primary lung cancer(MPLC)is a rare type of primary lung cancer,recently there has been a gradual increase in the number of patients with MPLC.The aim of this study is to investigate the diagnosis,treatment principle of MPLC.Methods: Twenty-one patients were diagnosed MPLC by Martini-Melamed criteria.Their clinicopathological data were reviewed retrospectively.All 21 patients underwent surgical treatment,there were 1 patient with pneumonectomy,1 patient with lobectomy-segmentectomy,10 patiens with lobectomy-lobectomy,6 patients with lobectomy-wedge resection,and 18 patients with systematic mediastinal lymphadenectomy,6 patients with lymph node sampling.Results: Four patients suffered from triple primary lung cancer and 17 patients from double primary lung cancer.There were 15 patients with synchronous MPLC,6 patients with metachronous MPLC.Of 46 lesions,the surgical procedures mainly included lobectomy(67.4%,31/46).Lesions(39.1%,18/46)were most frequently seen in right upper lobe.Pathological type was mainly adenocarcinoma(78.3%,36/46),followed by squamous cell carcinoma(21.7%,10/46).Of 36 adenocarcinoma specimens,the papillary predominant subtype was more common(55.6%,20/36).Meanwhile 90.5%(19/21)of the lesions were stage I.As to the initial cancer and repeated cancer,patients who shared the same pathological type(71.4 %,15/21)were more than the different type(28.6%,6/21),of which adenocarcinoma-adenocarcinoma was most common(86.7%,13/15).Lesions located in contralateral lobes were in 12 patients(57.1%),in ipsilateral different lobes were in 5 patients(23.8%),while located in ipsilateral same lobes were in 4 patients(19.0%).Of 13 patients with adenocarcinoma-adenocarcinoma,4 patients had different EGFR mutation.Conclusion: Lesions in patients with multiple primary lung cancers are more frequently in the right upper lobe.The pathology type is mainly adenocarcinoma.The detection of molecular markers can be of tremendous help in the diagnosis of MPLC.It may be the preferred treatment that simultaneous or staged surgical treatment combined with Multidisciplinary therapy for MPLC.