The Efficacy of PD-1 Antibody Sulituzumab on Early-stage Multiple Primary Lung Cancer With Ground Glass Density.

ObjectiveThe incidence of early stage multiple primary lung cancer (MPLC) has been increasing in recent years, while the ideal strategy for its diagnosis and treatment remains controversial. The present study conducted genomic analysis to identify a new molecular classification method for accurately predicting the diagnosis and therapy for patients with early stage MPLC.MethodsA total of 240 tissue samples from 203 patients with multiple-non-small-cell lung cancers (NSCLCs) (n = 30), early stage single-NSCLC (Group A, n = 94), and advanced-stage NSCLC (Group B, n = 79) were subjected to targeted multigene panel sequencing.ResultsThirty patients for whom next-generation sequencing was performed on >1 tumor were identified, yielding 45 tumor pairs. The frequencies of EGFR, TP53, RBM10, ERBB2, and CDKN2A mutations exhibited significant differences between early and advanced-stage NSCLCs. The prevalence of the EGFR L858R mutation in early stage NSCLC was remarkably higher than that in advanced-stage NSCLC (P = 0.047). The molecular method classified tumor pairs into 26 definite MPLC tumors and four intrapulmonary metastasis (IM) tumors. A high rate of discordance in driver genetic alterations was found in the different tumor lesions of MPLC patients. The prospective Martini histologic prediction of MPLC was discordant with the molecular method for three patients (16.7%), particularly in the prediction of IM (91.7% discordant).ConclusionsComprehensive molecular evaluation allows the unambiguous delineation of clonal relationships among tumors. In comparison, the Martini and Melamed criteria have notable limitations in the recognition of IM. Our results support the adoption of a large panel to supplement histology for strongly discriminating NSCLC clonal relationships in clinical practice.

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Surgical treatment to multiple primary lung cancer patients: a systematic review and meta-analysis

BMC Surgery ◽

10.1186/s12893-019-0643-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Ting-Fei Chen ◽

Chun-Ying Xie ◽

Bing-Yu Rao ◽

Shi-Chao Shan ◽

Xin Zhang ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Wedge Resection ◽

Meta Analysis ◽

Primary Lung Cancer ◽

Systemic Review ◽

Sublobar Resection ◽

Resection Group ◽

Standard Resection ◽

Multiple Primary

Abstract Background As there is no consensus on the optimal surgery strategy for multiple primary lung cancer (MPLC), we conducted this study to address this issue by comparing the prognosis of MPLC patients underwent different surgical strategies including sublobar resection and the standard resection through a systemic review and meta-analysis. Methods Relevant literature was obtained from three databases including PubMed, Embase and Web of Science. Inclusion and exclusion criteria were set for the screening of articles to be selected for further conduction of systemic review and meta-analysis. The HRs of OS of the sublobar group compared with standard resection group were extracted directly or calculated indirectly from included researches. Results Ten researches published from 2000 to 2017 were included in this study, with 468 and 445 MPLC cases for the standard resection group and sublobar resection group respectively. The result suggested that OS of MPLC patients underwent sublobar resection (segmentectomy or wedge resection for at least one lesion) was comparable with those underwent standard resection approach (lobectomy or pneumonectomy for all lesions), with HR 1.07, 95% CI 0.67–1.71, p = 0.784. Further analysis found no difference in subgroups of synchronous and metachronous (from second metachronous lesion), different population region and dominant sex type. Conclusions This study may reveal that sublobar resection is acceptable for patients with MPLC at an early stage, because of the equivalent prognosis to the standard resection and better pulmonary function preservation. Further research is needed to validate these findings.

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Genetic and Immune Profile Discrepancies between Early-Stage Single Primary Lung Cancer and Synchronous Multiple Primary Lung Cancer

SSRN Electronic Journal ◽

10.2139/ssrn.3928494 ◽

2021 ◽

Author(s):

Chen Chen ◽

Qiang Wang ◽

Danting Zhou ◽

Xiaojie Huang ◽

Zhenyu Zhao ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Primary Lung Cancer ◽

Immune Profile ◽

Multiple Primary

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Surgical treatment to multiple primary lung cancer patients: A systematic review and meta-analysis

10.21203/rs.2.13229/v2 ◽

2019 ◽

Author(s):

Ting-Fei Chen ◽

Chun-Ying Xie ◽

Bing-Yu Rao ◽

Shi-Chao Shan ◽

Xin Zhang ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Wedge Resection ◽

Meta Analysis ◽

Primary Lung Cancer ◽

Systemic Review ◽

Sublobar Resection ◽

Resection Group ◽

Standard Resection ◽

Multiple Primary

Abstract Background As there is no consensus on the optimal surgery strategy for multiple primary lung cancer (MPLC), we conducted this study to address this issue by comparing the prognosis of MPLC patients underwent different surgical strategies including sublobar resection and the standard resection through a systemic review and meta-analysis. Methods Relevant literature was obtained from three databases including PubMed, Embase and Web of Science. Inclusion and exclusion criteria were set for the screening of articles to be selected for further conduction of systemic review and meta-analysis. The HRs of OS of the sublobar group compared with standard resection group were extracted directly or calculated indirectly from included researches. Result s: Ten researches published from 2000 to 2017 were included in this study, with 468 and 445 MPLC cases for the standard resection group and sublobar resection group respectively. The result suggested that OS of MPLC patients underwent sublobar resection (segmentectomy or wedge resection for at least one lesion) was comparable with those underwent standard resection approach (lobectomy or pneumonectomy for all lesions), with HR 1.07, 95% CI 0.67 - 1.71, p = 0.784. Further analysis found no difference in subgroups of synchronous and metachronous (from second metachronous lesion), different population region and dominant sex type. Conclusions This study may reveal that sublobar resection is acceptable for patients with MPLC at an early stage, because of the equivalent prognosis to the standard resection and better pulmonary function preservation. Further research is needed to validate these findings.

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Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer

Cancers ◽

10.3390/cancers14010242 ◽

2022 ◽

Vol 14 (1) ◽

pp. 242

Author(s):

Chi-Lu Chiang ◽

Ping-Chung Tsai ◽

Yi-Chen Yeh ◽

Yuan-Hung Wu ◽

Han-Shui Hsu ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Primary Lung Cancer ◽

Lung Cancer Screening ◽

Stereotactic Ablative Radiotherapy ◽

Early Stage Lung Cancer ◽

Local Ablation ◽

Diagnosis And Management ◽

Recent Advances ◽

Multiple Primary

With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.

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1227P Comprehensive molecular characterization of Chinese patients with early stage multiple primary lung cancer

Annals of Oncology ◽

10.1016/j.annonc.2020.08.1429 ◽

2020 ◽

Vol 31 ◽

pp. S799

Author(s):

G. Pei ◽

M. Li ◽

X. Min ◽

Q. Liu ◽

D. Li ◽

...

Keyword(s):

Lung Cancer ◽

Molecular Characterization ◽

Early Stage ◽

Primary Lung Cancer ◽

Chinese Patients ◽

Multiple Primary

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Multiomics analysis reveals a distinct response mechanism in multiple primary lung adenocarcinoma after neoadjuvant immunotherapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002312 ◽

2021 ◽

Vol 9 (4) ◽

pp. e002312

Author(s):

Chao Zhang ◽

Kai Yin ◽

Si-Yang Liu ◽

Li-Xu Yan ◽

Jian Su ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Primary Lung Cancer ◽

Human Leukocyte ◽

Cell Receptor ◽

Lymphocyte Function ◽

Multiple Cancer ◽

Neoadjuvant Immunotherapy ◽

Programmed Death ◽

Multiple Primary

Multiple primary lung cancer (MPLC) remains a tough challenge to diagnose and treat. Although neoadjuvant immunotherapy has shown promising results in early stage non-small cell lung cancer, whether such modality can benefit all primary lesions remains unclear. Herein, we performed integrated multiomics analysis in one patient with early stage MPLC with remarkable tumor shrinkage in a solid nodule and no response in two subsolid nodules after treatment with three cycles of neoadjuvant pembrolizumab. Genomic heterogeneity was observed among responding nodules with high levels of infiltrating CD8+ and CD68+ immune cells. Substantially downregulated human leukocyte antigen (HLA)-related genes and impaired T lymphocyte function were observed in non-responding nodules. A larger proportion of infiltrating tissue resident memory T cells (Trm) along with high T cell receptor repertoire clonality in responding nodules were validated as predictive and prognostic biomarkers in multiple cancer types using external public datasets. These results suggested that neoadjuvant programmed death 1 (PD-1)/programmed death ligand 1 inhibitors alone may not be an optimal therapeutic strategy for MPLC due to disparities in genomic alterations and immune microenvironment among different lesions. Additionally, we postulate that increased infiltration of Trm may be a unique marker of early immune responses to PD-1 blockade.

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Simultaneous Bilateral Thoracoscopic Pneumonectomy for Early Multiple Primary Lung Cancer Feasibility Analysis

Proceedings of Anticancer Research ◽

10.26689/par.v5i3.2160 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Zhonglong Zheng ◽

Tao Li ◽

Yang Chen ◽

Yang Zhang ◽

Pan Zhang

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Thoracoscopic Surgery ◽

Primary Lung Cancer ◽

Operation Time ◽

Time Range ◽

Control Group ◽

Study Group ◽

Significant Difference ◽

Multiple Primary

Objective: To analyze the feasibility of simultaneous bilateral thoracoscopic lung resection in the treatment of multiple primary lung cancers in the early stage. Methods: The study time range is between March 2019 and March 2021. A sample of 30 patients with early multiple primary lung cancer admitted to this hospital were included, and they were divided into a study group, a control group, and samples within the group using a random number table scheme n=15, patients in the control group underwent staged bilateral thoracoscopic pneumonectomy, and patients in the study group underwent bilateral thoracoscopic pneumonectomy at the same time. The indicators of the two groups were compared and analyzed. Results: There was no significant difference in the operation time and intraoperative blood loss between the two groups (P>0.05). There were significant differences in the VAS score, total length of hospital stay, and total surgical costs on the first day after surgery (P<0.05); there was no significant difference in the two groups' postoperative recovery indicators and the incidence of complications (P>0.05). Conclusion: It is safe and feasible to treat patients with multiple primary lung cancer in both lungs at the same time with simultaneous bilateral thoracoscopic surgery, and is suitable for promotion.

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Surgical treatment to multiple primary lung cancer patients: A systematic review and meta-analysis

10.21203/rs.2.13229/v1 ◽

2019 ◽

Author(s):

Ting-Fei Chen ◽

Chun-Ying Xie ◽

Bing-Yu Rao ◽

Shi-Chao Shan ◽

Xin Zhang ◽

...

Keyword(s):

Lung Cancer ◽

Early Stage ◽

Wedge Resection ◽

Meta Analysis ◽

Primary Lung Cancer ◽

Systemic Review ◽

Sublobar Resection ◽

Resection Group ◽

Standard Resection ◽

Multiple Primary

Abstract Background As there is no consensus on the optimal surgery strategy for multiple primary lung cancer (MPLC), we conducted this study to address this issue by comparing the prognosis of MPLC patients underwent different surgical strategies including sublobar resection and the standard resection through a systemic review and meta-analysis. Methods Relevant literature was obtained from three databases including PubMed, Embase and Web of Science. Inclusion and exclusion criteria were set for the screening of articles to be selected for further conduction of systemic review and meta-analysis. The HRs of OS of the sublobar group compared with standard resection group were extracted directly or calculated indirectly from included researches. Result s: Ten researches published from 2000 to 2017 were included in this study, with 468 and 445 MPLC cases for the standard resection group and sublobar resection group respectively. The result suggested that OS of MPLC patients underwent sublobar resection (segmentectomy or wedge resection for at least one lesion) was comparable with those underwent standard resection approach (lobectomy or pneumonectomy for all lesions), with HR 1.07, 95% CI 0.67 - 1.71, p = 0.784. Further analysis found no difference in subgroups of synchronous and metachronous (from second metachronous lesion), different population region and dominant sex type. Conclusions This study may reveal that sublobar resection is acceptable for patients with MPLC at an early stage, because of the equivalent prognosis to the standard resection and better pulmonary function preservation. Further research is needed to validate these findings.

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