Clinical And Basic Study On The Synchronous Multiple Primary Lung Cancer

Objective : As a special type of lung cancer,synchronous multiple primary lung cancer(s MPLC)has a gradually increasing morbidity in recent years.However,there has been a lack of studies on large sample about it domestic and overseas.Our studies are designed to investigate the prevention,diagnosis,treatment and prognosis of s MPLC by analyzing the clinical data of the 357 patents in our hospital,and afford supports for the management of s MPLC.Methods:Three hundred and fifty-seven patients were diagnosed with s MPLC by the Martini-Melamed criteria.The pathological criteria in our study is based on the 8th edition Tumor-Node-Metastasis(TNM)staging published by IASLC.Most of the clinicopathological features of the patients involved,such as gender,age,numeber,pathological pattern,smoking history,location,imaging characteristics,T-stage,N-stage and overall survival,are taken into account.Results: There are 269 patients with geminate primary lesion,65 patients with triple primary lesion and 23 patients with four or more.The incidence of women is higher than that of men(0.44:1).Most of the tumors are located in the upper lobe(68.55%,571/833),especially the upper right lobe.Adenocarcinoma(95.56%,796/833)is the staple pathological pattern,and the squamous cell carcinoma(2.40%,20/833)follows.The acinar subtype ranks the main portion(70.81%,313/442)of the adenocarcinoma cases.The majority of the tumours(68.35%,244/357)are stage?b or lower.Among the primary tum-our and the following tumours,patients who have the same pathol-ogical pattern(92.72%,331/357)are more than the different ones(7.28%,26/357),of which AD-AD occupies the mean portion(99.40%,329/331).The 5-year overall survival and 3-year overall survival are 84.37% and 91.93%,respectively.Multivariate analysis indicates that smoking history(P=0.012),pleural involvement(P ? 0.001),the diamet-er of the maximal tumour(P=0.027)and lymph nodes metastasis(P=0.015)are independent prognostic factors.Conclusions: Synchronous multiple primary lung cancer is more common in women.Most of the lesions occur in the right upper lobe.Adenocarcinoma ranks the main pathological pattern.the diameter of the maximal tumor,smoking history,pleural involvement and lymph node metastasis are the independent prognostic factors.Early diagnosis and aggressive surgical treatment can improve the prognosis.Objective : There has been a gradual increase in the morbidity of synchronous multiple primary lung cancer(s MPLC)in recent years,and the differential diagnosis of s MPLC is still a complicated and intricate matter to the clinician.Our study is designed to explore molecular markers to distinguish s MPLC and intrapulmonary metastatic carcinoma(IPMC)by testing the expression level of Snail and E-cadherin,and offers theoretical supports for the management of s MPLC.Methods: We test the expression level of Snail and E-cadherin in the group between s MPLC(20 case),inchoate singular lung cancer(20 case)and IPMC(20 case)by immunohistochemistry technique.And then we compare the difference between each group.Results:Snail protein meanly locates in cytoplasm and caryon.The high-expression rate of Snail in the s MPLC,ISLC and IPMC are 35%(7/20),25%(5/20)and 80%(16/20)respectively.The difference of the high-expression between IPMC and s MPLC is significant(P=0.004),so is the difference between ISLC and IPMC(P?0.001).But The difference between s MPLC and ISLC is poor(P=0.490).E-cadherin protein meanly locates in cytomembrane.The low-expression rate of E-cadherin in the s MPLC,ISLC and IPMC are 50%(10/20),50%(10/20)and(17/20)respectively.The difference of the low-expression between IPMC and s MPLC is significant(P=0.018),so is the difference between ISLC and IPMC(P=0.003).But The difference between s MPLC and ISLC is poor(P=0.525).According the results of the immunohistochemistry,we grade a score to each case in three groups.We use t test to compare the difference in score between each group.We find that the mean score of Snail in IPMC is higher than that of s MPLC(P?0.001)and ISLC(P?0.001).Similarly,the mean score of E-cadherin in IPMC is lower than that of s MPLC(P?0.001)and ISLC(P?0.001).However,difference of the mean score of Snail in s MPLC and ISLC is non-significant,so is E-cadherin.Conclusion:The expression level of Snail and E-cadherin between s MPLC and IPMC is significantly different,and we can use them as molecular markers to distinguish s MPLC and IPMC.