Progress in diagnosis and treatment strategies for multiple primary lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yixiang , XIE Qiang ,  GU Chundong

1. Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, P.R.China;
2. Lung Cancer Diagnosis and Treatment Center of Dalian, Dalian, 116011, Liaoning, P.R.China;

Corresponding author：

GU Chundong, Email: guchundong@dmu.edu.cn

Keywords：

Multiple primary lung cancer; diagnosis; simultaneous bilateral operation; local ablation

DOI：

10.7507/1007-4848.202005009

Video：

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Abstract Full text Figures/Tables Video References Cited by

Multiple primary lung cancer is a special type of lung cancer. Its detection rate is increasing year by year, and there is no clear diagnosis and treatment strategy, which makes the diagnosis and treatment become a hotspot in clinical work. The molecular genetics is gradually changing the status quo of relying only on imaging and tumor-free interval to distinguish lung metastasis from multiple primary lung cancer, and it is an effective method for differential diagnosis and prediction of biological behavior of lung cancer. Based on our experience and other studies, it is recommended that surgical treatment should be preferred when there is no contraindication. The advantages and disadvantages of bilateral thoracoscopic surgery for bilateral multiple primary lung cancer during the same period are discussed, and its feasibility and safety are confirmed. For the lesions that cannot be completely resected, active surgical local treatment is recommended. The diagnosis and treatment of multiple primary lung cancer is still a clinical difficulty, and we hope that our research can provide theoretical and practical guidance for clinicians.

Citation： ZHANG Yixiang, XIE Qiang, GU Chundong. Progress in diagnosis and treatment strategies for multiple primary lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(5): 609-614. doi: 10.7507/1007-4848.202005009 Copy

1.	Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
2.	Li X, Hu B, Li H, et al. Application of artificial intelligence in the diagnosis of multiple primary lung cancer. Thorac Cancer, 2019, 10(11): 2168-2174.
3.	任凡, 陈军. 多原发肺癌诊断和治疗策略的系统性综述. 药品评价, 2017, 14(16): 31-41.
4.	Madersbacher S, Lackner J, Brössner C, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: A nation-wide, long-term analysis of 23,123 cases. Eur Urol, 2005, 47(4): 499-504.
5.	Shen KR, Meyers BF, Larner JM, et al. Special treatment issues in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 290S-305S.
6.	Jiang L, He J, Shi X, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: Systematic review and meta-analysis. Lung Cancer, 2015, 87(3): 303-310.
7.	Li J, Yang X, Xia T, et al. Stage Ⅰ synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis. J Thorac Dis, 2017, 9(12): 5335-5344.
8.	Guo T, Zhao S, Li Z, et al. Elevated MACC1 expression predicts poor prognosis in small invasive lung adenocarcinoma. Cancer Biomark, 2018, 22(2): 301-310.
9.	Zhao S, Guo W, Li J, et al. High expression of Y-box-binding protein 1 correlates with poor prognosis and early recurrence in patients with small invasive lung adenocarcinoma. Onco Targets Ther, 2016, 9: 2683-2692.
10.	耿振英, 焦顺昌, 王甦, 胡毅. 106 例多原发癌的临床回顾性研究. 世界最新医学信息文摘, 2017, 17(12): 1-2, 19.
11.	谭黎杰, 尹俊. 多原发肺癌的诊疗. 中国肺癌杂志, 2018, 21(3): 185-189.
12.	梁精, 李爱民, 张军一. 多原发肺癌的诊断和处理策略新进展. 中国实用医药, 2019, 14(20): 190-192.
13.	Antakli T, Schaefer RF, Rutherford JE, et al. Second primary lung cancer. Ann Thorac Surg, 1995, 59(4): 863-866.
14.	Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive Summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): 7S-37S.
15.	Detterbeck FC. Multifocal adenocarcinoma: perspectives, assumptions and elephants. J Thorac Dis, 2018, 10(3): 1193-1197.
16.	Goo JM, Park CM, Lee HJ. Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol, 2011, 196(3): 533-543.
17.	Henschke CI, Yankelevitz DF, Naidich DP, et al. CT screening for lung cancer: Suspiciousness of nodules according to size on baseline scans. Radiology, 2004, 231(1): 164-168.
18.	罗汶鑫, 周萍, 李为民. 多原发性肺癌的诊治进展. 中国肺癌杂志, 2015, 18(10): 640-643.
19.	McGranahan N, Swanton C. Clonal heterogeneity and tumor evolution: Past, present, and the future. Cell, 2017, 168(4): 613-628.
20.	Ma P, Fu Y, Cai MC, et al. Simultaneous evolutionary expansion and constraint of genomic heterogeneity in multifocal lung cancer. Nat Commun, 2017, 8(1): 823.
21.	Birrer MJ, Brown PH. Application of molecular genetics to the early diagnosis and screening of lung cancer. Cancer Res, 1992, 52(9 Suppl): 2658s-2664s.
22.	Zhao S, Guo T, Li J, et al. Expression and prognostic value of GalNAc-T3 in patients with completely resected small (≤2 cm) peripheral lung adenocarcinoma after IASLC/ATS/ERS classification. Onco Targets Ther, 2015, 8: 3143-3152.
23.	鲍轶, 莫娟芬. 高通量测序在多原发肺癌的诊断及解码肺癌进化的价值. 医学研究杂志, 2019, 48(7): 168-170.
24.	Eguren-Santamaria I, Sanchez-Bayona R, Patiño-Garcia A, et al. Targeted DNA sequencing for assessing clonality in multiple lung tumors: A new approach to an old dilemma. Lung Cancer, 2018, 122: 120-123.
25.	Xu G, Fu X. One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules. J Thorac Dis, 2019, 11(2): 535-541.
26.	宋从宽, 沈小艳, 汪育锦, 等. 多原发肺癌的诊疗进展. 武汉大学学报(医学版), 2020, 41(3): 433-437.
27.	Peng Y, Ren W, Wang H, et al. Surgical treatment is an effective approach for patients with synchronous multiple primary lung cancers. J Cancer Res Ther, 2017, 13(4): 702-706.
28.	Yang H, Sun Y, Yao F, et al. Surgical therapy for bilateral multiple primary lung cancer. Ann Thorac Surg, 2016, 101(3): 1145-1152.
29.	章智荣, 毛友生, 高树庚, 等. 双侧同时多原发性非小细胞肺癌外科治疗疗效分析. 中华肿瘤杂志, 2016, 38(6): 460-465.
30.	Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg, 2003, 125(4): 924-928.
31.	Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
32.	韩连奎, 高树庚, 谭锋维, 等. 同时性多原发肺癌的诊治体会及处理策略新进展. 中国肺癌杂志, 2018, 21(3): 180-184.
33.	Trousse D, Barlesi F, Loundou A, et al. Synchronous multiple primary lung cancer: An increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg, 2007, 133(5): 1193-1200.
34.	Shennib H. Sublobar resection for lung cancer. Eur J Cardiothorac Surg, 1999, 16(Suppl 1): S61-63.
35.	Fan J, Wang L, Jiang GN, et al. Sublobectomy versus lobectomy for stage Ⅰ non-small-cell lung cancer, a meta-analysis of published studies. Ann Surg Oncol, 2012, 19(2): 661-668.
36.	Bi N, Shedden K, Zheng X, et al. Comparison of the effectiveness of radiofrequency ablation with stereotactic body radiation therapy in inoperable stage Ⅰ non-small cell lung cancer: A systemic review and pooled analysis. Int J Radiat Oncol Biol Phys, 2016, 95(5): 1378-1390.
37.	Liu B, Liu L, Hu M, et al. Percutaneous radiofrequency ablation for medically inoperable patients with clinical stage Ⅰ non-small cell lung cancer. Thorac Cancer, 2015, 6(3): 327-333.
38.	刘宝东, 刘磊, 李岩, 等. 射频消融治疗 100 例肺部肿瘤的远期疗效. 中国肺癌杂志, 2011, 14(4): 335-339.
39.	Kim C, Hoang CD, Kesarwala AH, et al. Role of local ablative therapy in patients with oligometastatic and oligoprogressive non-small cell lung cancer. J Thorac Oncol, 2017, 12(2): 179-193.
40.	刘宝东, 叶欣, 范卫君, 等. 影像引导射频消融治疗肺部肿瘤专家共识(2018 年版). 中国肺癌杂志, 2018, 21(2): 76-88, 86.
41.	Kashima M, Yamakado K, Takaki H, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: A single center's experiences. AJR Am J Roentgenol, 2011, 197(4): W576-580.
42.	Welch BT, Brinjikji W, Schmit GD, et al. A national analysis of the complications, cost, and mortality of percutaneous lung ablation. J Vasc Interv Radiol, 2015, 26(6): 787-791.
43.	de Baere T, Tselikas L, Catena V, et al. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging, 2016, 97(10): 1019-1024.
44.	Liu M, He W, Yang J, et al. Surgical treatment of synchronous multiple primary lung cancers: A retrospective analysis of 122 patients. J Thorac Dis, 2016, 8(6): 1197-1204.
45.	Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
46.	梁宝磊, 蔡庆勇, 梁贵友, 等. 剑突下单孔胸腔镜同期处理双侧胸部疾病的疗效分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1064-1067.
47.	刘涛, 何海丽, 郭建极, 等. 经剑突单孔胸腔镜同期切除双侧肺肿瘤 11 例. 中华实验外科杂志, 2017, 34(4): 706.
48.	王春阳, 赵江洋, 张鹤. 同期双侧胸腔镜手术在肺癌外科治疗中的应用价值. 中国保健营养, 2020, 30(3): 53, 55.
49.	Zhang Y, Wang Y, Lv C, et al. Clinical analysis of 56 cases of simultaneous bilateral video-assisted thoracoscopic surgery for bilateral synchronous multiple primary lung adenocarcinoma. J Thorac Dis, 2018, 10(12): 6452-6457.
50.	Rusthoven CG, Yeh N, Gaspar LE. Radiation therapy for oligometastatic non-small cell lung cancer: Theory and practice. Cancer J, 2015, 21(5): 404-412.
51.	Ye X, Fan W, Wang H, et al. Expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors (2018 edition). J Cancer Res Ther, 2018, 14(4): 730-744.
52.	Gazdar AF. The molecular and cellular basis of human lung cancer. Anticancer Res, 1994, 14(1B): 261-267.
53.	Mathisen DJ, Jensik RJ, Faber LP, et al. Survival following resection for second and third primary lung cancers. J Thorac Cardiovasc Surg, 1984, 88(4): 502-510.
54.	Strand TE, Rostad H, Møller B, et al. Survival after resection for primary lung cancer: a population based study of 3211 resected patients. Thorax, 2006, 61(8): 710-715.
55.	Xue X, Xue Q, Wang N, et al. Early clinical diagnosis of synchronous multiple primary lung cancer. Oncol Lett, 2012, 3(1): 234-237.
56.	Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg, 2007, 134(3): 630-637.
57.	Voltolini L, Rapicetta C, Luzzi L, et al. Surgical treatment of synchronous multiple lung cancer located in a different lobe or lung: High survival in node-negative subgroup. Eur J Cardiothorac Surg, 2010, 37(5): 1198-1204.
58.	Liu C, Li H, Xu K, et al. Multiple primary lung cancer versus intrapulmonary metastatic cancer: A case of multiple pulmonary nodules. Thorac Cancer, 2019, 10(2): 352-358.
59.	Romaszko AM, Doboszyńska A. Multiple primary lung cancer: A literature review. Adv Clin Exp Med, 2018, 27(5): 725-730.

1. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
2. Li X, Hu B, Li H, et al. Application of artificial intelligence in the diagnosis of multiple primary lung cancer. Thorac Cancer, 2019, 10(11): 2168-2174.
3. 任凡, 陈军. 多原发肺癌诊断和治疗策略的系统性综述. 药品评价, 2017, 14(16): 31-41.
4. Madersbacher S, Lackner J, Brössner C, et al. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: A nation-wide, long-term analysis of 23,123 cases. Eur Urol, 2005, 47(4): 499-504.
5. Shen KR, Meyers BF, Larner JM, et al. Special treatment issues in lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 290S-305S.
6. Jiang L, He J, Shi X, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: Systematic review and meta-analysis. Lung Cancer, 2015, 87(3): 303-310.
7. Li J, Yang X, Xia T, et al. Stage Ⅰ synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis. J Thorac Dis, 2017, 9(12): 5335-5344.
8. Guo T, Zhao S, Li Z, et al. Elevated MACC1 expression predicts poor prognosis in small invasive lung adenocarcinoma. Cancer Biomark, 2018, 22(2): 301-310.
9. Zhao S, Guo W, Li J, et al. High expression of Y-box-binding protein 1 correlates with poor prognosis and early recurrence in patients with small invasive lung adenocarcinoma. Onco Targets Ther, 2016, 9: 2683-2692.
10. 耿振英, 焦顺昌, 王甦, 胡毅. 106 例多原发癌的临床回顾性研究. 世界最新医学信息文摘, 2017, 17(12): 1-2, 19.
11. 谭黎杰, 尹俊. 多原发肺癌的诊疗. 中国肺癌杂志, 2018, 21(3): 185-189.
12. 梁精, 李爱民, 张军一. 多原发肺癌的诊断和处理策略新进展. 中国实用医药, 2019, 14(20): 190-192.
13. Antakli T, Schaefer RF, Rutherford JE, et al. Second primary lung cancer. Ann Thorac Surg, 1995, 59(4): 863-866.
14. Detterbeck FC, Lewis SZ, Diekemper R, et al. Executive Summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): 7S-37S.
15. Detterbeck FC. Multifocal adenocarcinoma: perspectives, assumptions and elephants. J Thorac Dis, 2018, 10(3): 1193-1197.
16. Goo JM, Park CM, Lee HJ. Ground-glass nodules on chest CT as imaging biomarkers in the management of lung adenocarcinoma. AJR Am J Roentgenol, 2011, 196(3): 533-543.
17. Henschke CI, Yankelevitz DF, Naidich DP, et al. CT screening for lung cancer: Suspiciousness of nodules according to size on baseline scans. Radiology, 2004, 231(1): 164-168.
18. 罗汶鑫, 周萍, 李为民. 多原发性肺癌的诊治进展. 中国肺癌杂志, 2015, 18(10): 640-643.
19. McGranahan N, Swanton C. Clonal heterogeneity and tumor evolution: Past, present, and the future. Cell, 2017, 168(4): 613-628.
20. Ma P, Fu Y, Cai MC, et al. Simultaneous evolutionary expansion and constraint of genomic heterogeneity in multifocal lung cancer. Nat Commun, 2017, 8(1): 823.
21. Birrer MJ, Brown PH. Application of molecular genetics to the early diagnosis and screening of lung cancer. Cancer Res, 1992, 52(9 Suppl): 2658s-2664s.
22. Zhao S, Guo T, Li J, et al. Expression and prognostic value of GalNAc-T3 in patients with completely resected small (≤2 cm) peripheral lung adenocarcinoma after IASLC/ATS/ERS classification. Onco Targets Ther, 2015, 8: 3143-3152.
23. 鲍轶, 莫娟芬. 高通量测序在多原发肺癌的诊断及解码肺癌进化的价值. 医学研究杂志, 2019, 48(7): 168-170.
24. Eguren-Santamaria I, Sanchez-Bayona R, Patiño-Garcia A, et al. Targeted DNA sequencing for assessing clonality in multiple lung tumors: A new approach to an old dilemma. Lung Cancer, 2018, 122: 120-123.
25. Xu G, Fu X. One-stage video-assisted thoracic surgery for bilateral multiple pulmonary nodules. J Thorac Dis, 2019, 11(2): 535-541.
26. 宋从宽, 沈小艳, 汪育锦, 等. 多原发肺癌的诊疗进展. 武汉大学学报(医学版), 2020, 41(3): 433-437.
27. Peng Y, Ren W, Wang H, et al. Surgical treatment is an effective approach for patients with synchronous multiple primary lung cancers. J Cancer Res Ther, 2017, 13(4): 702-706.
28. Yang H, Sun Y, Yao F, et al. Surgical therapy for bilateral multiple primary lung cancer. Ann Thorac Surg, 2016, 101(3): 1145-1152.
29. 章智荣, 毛友生, 高树庚, 等. 双侧同时多原发性非小细胞肺癌外科治疗疗效分析. 中华肿瘤杂志, 2016, 38(6): 460-465.
30. Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg, 2003, 125(4): 924-928.
31. Okada M, Koike T, Higashiyama M, et al. Radical sublobar resection for small-sized non-small cell lung cancer: A multicenter study. J Thorac Cardiovasc Surg, 2006, 132(4): 769-775.
32. 韩连奎, 高树庚, 谭锋维, 等. 同时性多原发肺癌的诊治体会及处理策略新进展. 中国肺癌杂志, 2018, 21(3): 180-184.
33. Trousse D, Barlesi F, Loundou A, et al. Synchronous multiple primary lung cancer: An increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg, 2007, 133(5): 1193-1200.
34. Shennib H. Sublobar resection for lung cancer. Eur J Cardiothorac Surg, 1999, 16(Suppl 1): S61-63.
35. Fan J, Wang L, Jiang GN, et al. Sublobectomy versus lobectomy for stage Ⅰ non-small-cell lung cancer, a meta-analysis of published studies. Ann Surg Oncol, 2012, 19(2): 661-668.
36. Bi N, Shedden K, Zheng X, et al. Comparison of the effectiveness of radiofrequency ablation with stereotactic body radiation therapy in inoperable stage Ⅰ non-small cell lung cancer: A systemic review and pooled analysis. Int J Radiat Oncol Biol Phys, 2016, 95(5): 1378-1390.
37. Liu B, Liu L, Hu M, et al. Percutaneous radiofrequency ablation for medically inoperable patients with clinical stage Ⅰ non-small cell lung cancer. Thorac Cancer, 2015, 6(3): 327-333.
38. 刘宝东, 刘磊, 李岩, 等. 射频消融治疗 100 例肺部肿瘤的远期疗效. 中国肺癌杂志, 2011, 14(4): 335-339.
39. Kim C, Hoang CD, Kesarwala AH, et al. Role of local ablative therapy in patients with oligometastatic and oligoprogressive non-small cell lung cancer. J Thorac Oncol, 2017, 12(2): 179-193.
40. 刘宝东, 叶欣, 范卫君, 等. 影像引导射频消融治疗肺部肿瘤专家共识(2018 年版). 中国肺癌杂志, 2018, 21(2): 76-88, 86.
41. Kashima M, Yamakado K, Takaki H, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: A single center's experiences. AJR Am J Roentgenol, 2011, 197(4): W576-580.
42. Welch BT, Brinjikji W, Schmit GD, et al. A national analysis of the complications, cost, and mortality of percutaneous lung ablation. J Vasc Interv Radiol, 2015, 26(6): 787-791.
43. de Baere T, Tselikas L, Catena V, et al. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging, 2016, 97(10): 1019-1024.
44. Liu M, He W, Yang J, et al. Surgical treatment of synchronous multiple primary lung cancers: A retrospective analysis of 122 patients. J Thorac Dis, 2016, 8(6): 1197-1204.
45. Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
46. 梁宝磊, 蔡庆勇, 梁贵友, 等. 剑突下单孔胸腔镜同期处理双侧胸部疾病的疗效分析. 中国胸心血管外科临床杂志, 2018, 25(12): 1064-1067.
47. 刘涛, 何海丽, 郭建极, 等. 经剑突单孔胸腔镜同期切除双侧肺肿瘤 11 例. 中华实验外科杂志, 2017, 34(4): 706.
48. 王春阳, 赵江洋, 张鹤. 同期双侧胸腔镜手术在肺癌外科治疗中的应用价值. 中国保健营养, 2020, 30(3): 53, 55.
49. Zhang Y, Wang Y, Lv C, et al. Clinical analysis of 56 cases of simultaneous bilateral video-assisted thoracoscopic surgery for bilateral synchronous multiple primary lung adenocarcinoma. J Thorac Dis, 2018, 10(12): 6452-6457.
50. Rusthoven CG, Yeh N, Gaspar LE. Radiation therapy for oligometastatic non-small cell lung cancer: Theory and practice. Cancer J, 2015, 21(5): 404-412.
51. Ye X, Fan W, Wang H, et al. Expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors (2018 edition). J Cancer Res Ther, 2018, 14(4): 730-744.
52. Gazdar AF. The molecular and cellular basis of human lung cancer. Anticancer Res, 1994, 14(1B): 261-267.
53. Mathisen DJ, Jensik RJ, Faber LP, et al. Survival following resection for second and third primary lung cancers. J Thorac Cardiovasc Surg, 1984, 88(4): 502-510.
54. Strand TE, Rostad H, Møller B, et al. Survival after resection for primary lung cancer: a population based study of 3211 resected patients. Thorax, 2006, 61(8): 710-715.
55. Xue X, Xue Q, Wang N, et al. Early clinical diagnosis of synchronous multiple primary lung cancer. Oncol Lett, 2012, 3(1): 234-237.
56. Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg, 2007, 134(3): 630-637.
57. Voltolini L, Rapicetta C, Luzzi L, et al. Surgical treatment of synchronous multiple lung cancer located in a different lobe or lung: High survival in node-negative subgroup. Eur J Cardiothorac Surg, 2010, 37(5): 1198-1204.
58. Liu C, Li H, Xu K, et al. Multiple primary lung cancer versus intrapulmonary metastatic cancer: A case of multiple pulmonary nodules. Thorac Cancer, 2019, 10(2): 352-358.
59. Romaszko AM, Doboszyńska A. Multiple primary lung cancer: A literature review. Adv Clin Exp Med, 2018, 27(5): 725-730.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress in diagnosis and treatment strategies for multiple primary lung cancer

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