Elsevier

Lung Cancer

Volume 73, Issue 2, August 2011, Pages 237-242
Lung Cancer

Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer

https://doi.org/10.1016/j.lungcan.2010.11.008Get rights and content

Abstract

Introduction

The development of synchronous multiple primary non-small cell lung cancer (NSCLC) is not rare. Nevertheless, the diagnosis, treatment and outcome are controversial. The purposes of this study were to assess the treatment outcomes for patients with synchronous multiple primary NSCLC and to analyze the factors related to this outcome.

Methods

We retrospectively analyzed clinical characteristics and treatment outcomes of 32 patients with synchronous multiple primary NSCLC who underwent surgical resection between 1995 and 2008.

Results

A total of 68 separate tumors were identified in 32 patients. Fifteen (46.9%) patients underwent lobectomy or pneumonectomy with mediastinal lymph node dissection, and 17 (53.1%) patients underwent at least one limited resection or photodynamic therapy. The rate of immediate postoperative mortality was 9.4% (N = 3). The five-year progression-free survival (PFS) and overall survival (OS) rates were 46.0% and 60.9%, respectively. Small tumor size, similar histology, pN0, and pT1 were associated with better PFS in univariable analyses. Female gender, young age, non-smoker, FEV1/FVC ≥70%, small tumor size, similar histology, and highest pT1 were associated with better OS in univariable analyses.

Conclusions

An aggressive surgical approach offers the greatest chance for long-term survival in patient with synchronous multiple primary NSCLC and several clinical factors were associated with survivals. However, the decision of aggressive surgical treatments for synchronous MPLC should be made carefully in the patients with old age and underlying comorbidities due to poor OS and increased surgical mortality.

Introduction

The incidence of synchronous multiple primary lung cancer is 0.2–20% [1], [2], [3]. Recently, the incidence has been increasing as a result of the widespread use of early detection tools such as multi-slice spiral computed tomography (CT), fluorescence endoscopy, and positron emission tomography (PET) scanning. The simultaneous discovery of additional pulmonary nodules in patients with lung cancer raises the clinical dilemma of whether these lesions represent intrapulmonary metastases or secondary primary lung cancer. A different histologic finding in two obviously distinguishable lung tumors is a strong argument in favor of the primary nature of both diseases. However, in the case of same histologic conditions, it is very difficult to differentiate a pulmonary metastasis from true synchronous primary lung cancer because genetic and molecular analyses are not always available in routine clinical practice.

The sixth revision of the tumor-node-metastases (TNM) staging system for non-small cell lung cancer (NSCLC) classifies the presence of a separate tumor nodule in the same as a T4 disease, whereas the presence in a different lobe is classified as an M1 disease [4]. However, based on survival data, the International Association for the Study of Lung Cancer (IASLC) proposed that patients with additional nodules in the same lobe should be reclassified as T3, and patients with additional nodules in the ipsilateral non-primary lobe should be reclassified as T4 disease [5]. Long-term survival after resection for patients with synchronous primary lung cancer has been reported to be better than that of patients with a tumor classified as stage IIIB or IV for reasons other than synchronous tumors [6], [7], [8]. For these reasons, most clinicians will agree that surgical resection offers the best chance for prolonged survival in these patients. However, there are still numerous controversial problems related to diagnosis, treatment and outcome in patients with synchronous multiple primary NSCLC.

The purposes of this study were to assess the results of treatment in patients with synchronous multiple primary NSCLC and to analyze the clinical and pathologic factors associated with outcome in these patients.

Section snippets

Patients

We performed a retrospective study. Among 4286 patients with NSCLC who underwent surgical resection at the Samsung Medical Center between January 1995 and December 2008, we enrolled only the patients with synchronous multiple primary NSCLC. We used the following criteria modified from Martini and Melamed [9] for the diagnosis of synchronous multiple primary NSCLC:

  • A.

    Tumors with different histologies

  • B.

    Tumors with similar histologies

    • (1)

      arising in a different segment, lobe or lung

    • (2)

      with no distant metastasis

Patients

There were total 32 patients with synchronous multiple primary NSCLC (Table 1), consisting of 22 males (68.8%) and ten females (31.3%). Their ages ranged from 30 to 77 years, with a median of 65 years. A total of 22 patients were current (50%) or ex-smokers (18.8%), and the median tobacco consumption was 35 (3–120) pack-years for all but two of the patients who had smoked an unknown amount of cigarettes. Three patients (9.4%) had a previous history of an additional extrathoracic malignancy

Discussion

In our retrospective study of patients with synchronous multiple primary NSCLC, five-year OS and PFS rates were 60.9% and 46.0%, respectively. Although the median period of follow-up was short, these results were quite favorable and comparable with those of other reports [6], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23]. We found that female gender, young age, non-smoker, FEV1/FVC ≥70%, small tumor size, similar histology, and highest pT1 were associated with better

Conflict of interest statement

None declared.

Acknowledgement

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A090909).

References (29)

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