Clinical And Molecular Level Analysis Of Related Genes In Multiple Primary Lung Cancer

Background and objective:Simultaneous multiple primary lung cancer(SMPLC)reported in earlier literatures is a relatively rare type of lung cancer.But in recent years,its incidence has been on the rise.In this study,the clinical and pathological data of 115SMPLC patients were analyzed and summarized to explore the timing of surgery for multiple primary lung cancer,as well as the value of gene testing in the diagnosis of multiple primary lung cancer,so as to provide a corresponding reference for clinical diagnosis,treatment and prognosis.Methods:Based on the Martini-Melamed diagnostic criteria and the International Association for the Study of Lung Cancer 8th Edition Tumor-Node-Metastasis(TNM)staging criteria,a retrospective analysis was performed between October 2018 and October 2020.Clinical data of lung cancer patients who received thoracoscopic surgery in the Department of Thoracic Surgery,East Hospital of Qingdao University were summarized and analyzed on the clinical and pathological data of 115 cases of SMPLC,and compared the supplement of genetic testing methods to the number of undiagnosed cases of traditional diagnostic criteria for multiple primary lung cancer.Compared with the single cancer group,the differences in gene and molecular level and the effect of recent surgery were compared.Results: There were 276 tumor lesions in 115 patients,including 88 cases(76.52%)with double primary lesions,19 cases(16.52%)with three primary lesions,8 cases(6.96%)with four or more primary lesions,and the maximum number of tumors was 8 lesions.There were more lesions in the upper lobe,and the most obvious lesions were in the right upper lobe(43.47%,120/276).The main histological types were lung adenocarcinoma(97.83%,270/276),followed by lung squamous cell carcinoma(1.44%,4/276).In the subtypes of adenocarcinoma,the proportion of acinoid lesions was higher(40%,108/270).The stages were mainly Ib stage and below(93.04%,107/115).The incidence rate of patients with different pathological types(58.26%,67/115)was higher than that of patients with the same pathological types(41.74%,48/115).The same pathological types and the same anatomical locations could not be distinguished by traditional M-M and ACCP standards.According to the results of genetic testing,there was obvious heterogeneity in tumor genesis.That is to say,there were 11 patients with independently developed lesions(9.57%,11/115).The proportion of adenocarcinoma to adenocarcinoma was higher(97.39%,112/115),the proportion of TP53 and HER2 mutations in MPLC patients was lower(10% vs 36.9%,3.3%vs 6.3%),and the proportion of KRAS and BRAF mutations was higher(20% vs 1.8%,20% vs9.9%).From the perspective of recent surgical efficacy,there was no significant difference in various postoperative indexes between the surgical methods of MPLC and the single lung cancer group.Conclusion: Second-generation gene sequencing can be used as a supplement to the traditional diagnostic criteria for multiple primary lung cancer.KRAS or BRAF mutation may be a factor in predicting or diagnosing MPLC to some extent.Propensity matching score analysis for surgical treatment of resectable lung cancer showed similar perioperative safety and short-term efficacy between the multiple group and the single group.