Preoperative Strategy for Identification of Multiple Primary Lung Adenocarcinomas

Yiliang Zhang

Fudan University Shanghai Cancer Center, 市辖区, China

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

Objective: We previously developed a histologic-mutational strategy for identification of multiple primary lung cancers. However, problems still remain that the methods rely on pathologic examination of resected specimen after surgery.This study was aimed to develop a diagnostic approach to settle the issue before surgery.

Methods: Between 2008 and 2016, consecutive patients with resected multiple lung adenocarcinomas were prospectively enrolled. Cases were defined by the preoperative CT features and validated by comprehensive histologic assessment after surgery. Survival was estimated between patients with multiple primary and metastatic disease to verify the differentiation.

Results: There were totally 695 patients included in this study. 610 (87.8%) patients were diagnosed as having independent primary tumors based on CT images before surgery, of which 486 (79.7%) presented as multiple ground-glass nodules (Multi-GGN) and 124 (20.3%) as one solid tumor plus one or more GGN (Solid-GGN). These 610 patients and the other 19 cases with multiple solid nodules (Multi-Solid) on CT, were defined as harboring different tumors through histologic assessment after surgery. 66 (9.5%) patients with Multi-Solid were undefined of the status even after comprehensive pathologic analysis on the surgical specimen.Multivariate analysis demonstrated thatMulti-Solid (HR=3.957, 95% CI, 1.533 to 10.22; P=.004), predominant subtype (HR=5.198, 95% CI, 1.359 to 19.89; P=.016) and pathologic N2 disease (HR=2.379, 95% CI, 1.256 to 4.506; P=.008) were independent factors that affect tumor recurrence.Only Multi-Solid was indicated as an independent predictor of poor OS (HR=20.54, 95% CI, 6.089 to 69.25; P=.000) after adjusting all the survival-associated factors.

Conclusions: Most of the multiple primary lung adenocarcinomas can be defined through preoperative CT analysis characterized by Multi-GGN or Solid-GGN. The Multi-solid was indicated as an independent predictor of poor survival, implying advanced disease.