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Radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer

  • Chest
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Abstract

Objective

To investigate the radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer (sMPLC).

Methods

From January 2013 to October 2019, 192 consecutive patients with sMPLC were investigated. The clinical, CT, molecular, and pathological features of all patients were analyzed. Furthermore, the prognosis of 89 patients who only underwent surgical resection was evaluated.

Results

Among 192 patients, all lesions pathologically confirmed or highly suspected as tumors based on radiological findings were retrospectively analyzed, and the CT findings of sMPLC were classified into three types: (I) all lesions manifested as solid nodules/masses (14.06%, 27/192), (II) all lesions manifested as subsolid nodules/masses (43.23%, 83/192), and (III) tumor lesions manifested as a combination of ≥ 2 of the following patterns: solid nodules/masses, subsolid nodules/masses, cystic airspace, and focal consolidation (42.71%, 82/192). For 252 tumors undergoing epidermal growth factor receptor (EGFR)–mutation testing, the EGFR-mutation rate was higher in subsolid tumors than that in solid tumors (p < 0.05). Among 19 patients with all tumors undergoing surgery and driver-gene testing, genetic heterogeneity was prevalent among the multiple tumors (63.16%,12/19). The highest clinical stage of non-I, ipsilateral distribution of tumors, and CT classification of I indicated a poor prognosis for patients with sMPLC (all p < 0.05).

Conclusion

Subsolid lesions are the most common presentation of sMPLC. Genetic heterogeneity in driver mutations among sMPLC may be present. Prognosis in patients with sMPLC is determined by the highest clinical TNM stage, distribution, and radiological classification among the multiple tumors.

Key Points

• Synchronous multiple primary lung cancer (sMPLC) has three types of CT findings.

• Genetic heterogeneity may be prevalent among the multiple tumors.

• Prognosis in patients with sMPLC is associated with the highest clinical TNM stage, distribution, and radiological classification among the multiple tumors.

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Abbreviations

ADC:

Adenocarcinoma

CT:

Computed tomography

EGFR:

Epidermal growth factor receptor

GGO:

Ground-glass opacity

IA:

Invasive adenocarcinoma

LADC:

Lung adenocarcinoma

mMPLC:

Metachronous multiple primary lung cancer

MPLC:

Multiple primary lung cancer

PACS:

Picture archiving and communication system

PFS:

Progression-free survival

sMPLC:

Synchronous multiple primary lung cancer

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Funding

This study has received funding from the Chongqing Science and Technology Commission (cstc2017jcyjAX0281 and cstc2016shms-ztzx10002) and Chongqing Health and Family Planning Commission (2022MSXM147) of China.

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Authors and Affiliations

  1. Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, Chongqing, 400016, China

    Ji-wen Huo, Tian-you Luo, Xiao-qun He, Jun-wei Gong, Fa-jin Lv & Qi Li

Authors
  1. Ji-wen Huo
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  2. Tian-you Luo
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  3. Xiao-qun He
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  4. Jun-wei Gong
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  5. Fa-jin Lv
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  6. Qi Li
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Corresponding author

Correspondence to Qi Li.

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Guarantor

The scientific guarantor of this publication is Qi Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

This study and all its protocols were approved by the ethics committee of our institute, written informed consent was not required for this study due to the retrospective nature.

Ethical approval

Institutional Review Board approval was obtained.

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• retrospective

• case-control study

• performed at one institution

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Huo, Jw., Luo, Ty., He, Xq. et al. Radiological classification, gene-mutation status, and surgical prognosis of synchronous multiple primary lung cancer. Eur Radiol 32, 4264–4274 (2022). https://doi.org/10.1007/s00330-021-08464-x

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  • DOI: https://doi.org/10.1007/s00330-021-08464-x

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