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. 2021 May;112(5):1924-1935.
doi: 10.1111/cas.14748. Epub 2021 Mar 9.

Clinical features and outcomes of patients with stage I multiple primary lung cancers

Yasushi Shintani  1 , Jiro Okami  2 , Hiroyuki Ito  3 , Takashi Ohtsuka  4 , Shinichi Toyooka  5 , Takeshi Mori  6 , Shun-Ichi Watanabe  7 , Hisao Asamura  8 , Masayuki Chida  9 , Hiroshi Date  10 , Shunsuke Endo  11 , Takeshi Nagayasu  12 , Ryoichi Nakanishi  13 , Etsuo Miyaoka  14 , Meinoshin Okumura  15 , Ichiro Yoshino  16 ; Japanese Joint Committee of Lung Cancer Registry
Affiliations

Clinical features and outcomes of patients with stage I multiple primary lung cancers

Yasushi Shintani et al. Cancer Sci. 2021 May.

Abstract

The number of patients with multiple primary lung cancers (MPLC) is rising. We studied the clinical features and factors related to outcomes of MPLC patients using the database of surgically resected lung cancer (LC) cases compiled by the Japanese Joint Committee of Lung Cancer Registry. From the 18 978 registered cases, 9689 patients with clinical stage I non-small-cell lung cancer who achieved complete resection were extracted. Tumors were defined as synchronous MPLC when multiple LC was simultaneously resected or treatment was carried out within 2 years after the initial surgery; metachronous MPLC was defined as second LC treated more than 2 years after the initial surgery. Of these cases, 579 (6.0%) were synchronous MPLC and 477 (5.0%) metachronous MPLC, with 51 overlapping cases. Female sex, nonsmoker, low consolidation-tumor ratio (CTR), and adenocarcinoma were significantly more frequent in the synchronous MPLC group, whereas patients with metachronous MPLC had higher frequencies of male sex, smoker, chronic obstructive pulmonary disease (COPD), and nonadenocarcinoma. There was no significant difference in survival rate between patients with and without synchronous or metachronous MPLC. Age, gender, CTR for second LC, and histological combination of primary and second LC were prognostic indicators for both types of MPLC. Logistic regression analysis showed that female sex, history of malignant disease other than LC, and COPD were risk factors for MPLC incidence. The present findings could have major implications regarding MPLC diagnosis and identification of independent prognostic factors, and provide valuable information for postoperative management of patients with MPLC.

Keywords: metachronous multiple primary lung cancer; non-small-cell lung cancer; registry; surgery; synchronous multiple primary lung cancer.

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Conflict of interest statement

Dr Asamura reports lecture fees from Medtronic, Johnson and Johnson, and Taiho Pharmaceutical. The remaining authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
A, Survival curves for patients with (red) and without (blue) synchronous multiple primary lung cancer (MPLC). Overall survival curves were estimated according to the Kaplan‐Meier method, and differences in survival were tested using the log rank method. B, Survival curves for patients with synchronous MPLC according to the consolidation‐tumor ratio (CTR) of the second lung cancer (LC). Red, CTR > 0.5; blue, CTR ≤ 0.5. C, Survival curves for patients with synchronous MPLC according to histological combination of primary and second LC. Red, histological combination without nonadenocarcinoma (non‐Ad); blue, histological combination including non‐Ad
FIGURE 2
FIGURE 2
A, Survival curves for patients with (red) and without (blue) metachronous multiple primary lung cancers (MPLC). B, Survival curves for patients with metachronous MPLC according to the consolidation‐tumor ratio (CTR) of the second lung cancer (LC). Red, CTR > 0.5; blue, CTR ≤ 0.5. C, Survival curves for patients with metachronous treatment for MPLC according to the histological combination of primary and second LC. Red, histological combination without nonadenocarcinoma (non‐Ad); blue, histological combination including non‐Ad
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