Short-term efficacy of surgical treatment for multiple pulmonary nodules: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Qi ^1,2 , GUO Ling ¹ , GAO Xin ¹ , XIE Shaohua ¹ , LI Qiang ¹ , ZHUANG Xiang ¹ ,  XIANG Run ¹

1. Department of Thoracic Surgery, Sichuan Cancer Hospital, Sichuan Cancer Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, Zigong Third People's Hospital, Zigong, 643020, Sichuan, P. R. China;

Corresponding author：

XIANG Run, Email: flying2020@yeah.net

Keywords：

Multiple pulmonary nodules; video-assisted thoracoscopic surgery; prognosis; surgical treatment

DOI：

10.7507/1007-4848.202207045

Video：

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Objective To summarize and analyze the clinical diagnosis, surgical treatment and prognosis of multiple pulmonary nodules (MPNs). Methods The clinical data of lung cancer patients who received surgical treatment in our hospital from 2018 to 2020 were collected. The short-term efficacy of surgical treatment for MPNs was analyzed. Results A total of 97 patients were enrolled, including 30 males and 67 females with an average age of 56.1±10.0 years at onset ill. There were 62 patients with double lesions, 22 patients with three lesions, 4 patients with four lesions, and 9 patients with more than four lesions. A total of 213 lesions were surgically treated, including 88 pure ground-glass nodules, 81 partially solid nodules, and 7 solid nodules. There were 87 simultaneous surgeries and 10 staged surgeries, with an average operation interval of 5.2 months. The pathological combination type included adenocarcinoma-adenocarcinoma in 96 (99.0%) patients, squamous cell carcinoma-squamous cell carcinoma in 1 (1.0%) patient, and no lymph node metastasis was found. The 2-year disease-free survival (DFS) rate was 92.1%, and the overall survival (OS) rate was 100.0%. Univariate analysis showed that high-risk lesion size>2 cm (P=0.316), residual lesions (P=0.782) and pathological combination type (P=0.913) had statistical effect on the 2-year DFS rate. Conclusion MPNs are mainly diagnosed with multiple primary lung cancers, and the pathological combination is mostly adenocarcinoma-adenocarcinoma combination. Imaging examination is of great help to the surgical approach selection, diagnosis and differential diagnosis of MPNs. During the operation, maximal preservation of lung function and complete resection of high-risk nodules should be taken as the principle, and the prognosis is satisfactory.

Citation： ZHANG Qi, GUO Ling, GAO Xin, XIE Shaohua, LI Qiang, ZHUANG Xiang, XIANG Run. Short-term efficacy of surgical treatment for multiple pulmonary nodules: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 255-262. doi: 10.7507/1007-4848.202207045 Copy

1.	van der Aalst CM, Ten Haaf K, de Koning HJ. Lung cancer screening: Latest developments and unanswered questions. Lancet Respir Med, 2016, 4(9): 749-761.
2.	Heuvelmans MA, Walter JE, Peters RB, et al. Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: The NELSON study. Lung Cancer, 2017, 113: 45-50.
3.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4.	张晓菊, 白莉, 金发光, 等. 肺结节诊治中国专家共识(2018年版). 中华结核和呼吸杂志, 2018, 41(10): 763-771.
5.	Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer, 2015, 88(2): 174-180.
6.	Sato Y, Fujimoto D, Morimoto T, et al. Natural history and clinical characteristics of multiple pulmonary nodules with ground glass opacity. Respirology, 2017, 22(8): 1615-1621.
7.	Chelala L, Hossain R, Kazerooni EA, et al. Lung-RADS version 1. 1: Challenges and a look ahead, from the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol, 2021, 216(6): 1411-1422.
8.	Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
9.	Leventakos K, Peikert T, Midthun DE, et al. Management of multifocal lung cancer: Results of a survey. J Thorac Oncol, 2017, 12(9): 1398-1402.
10.	Ettinger DS, Wood DE, Aggarwal C, et al. NCCN guidelines insights: Non-small cell lung cancer, version 1. 2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
11.	Galetta D, Solli P, Borri A, et al. Bilobectomy for lung cancer: Analysis of indications, postoperative results, and long-term outcomes. Ann Thorac Surg, 2012, 93(1): 251-257.
12.	Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
13.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
14.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301.
15.	Watanabe T, Tanahashi M, Suzuki E, et al. Surgical treatment for synchronous multiple primary lung cancer: Is it possible to achieve both curability and preservation of the pulmonary function? Thorac Cancer, 2021, 12(22): 2996-3004.
16.	Ghosh S, Mehta AC, Abuquyyas S, et al. Primary lung neoplasms presenting as multiple synchronous lung nodules. Eur Respir Rev, 2020, 29(157): 190142.
17.	魏星, 刘向阳. 同时性多原发肺腺癌31例临床分析与治疗体会. 中国医刊, 2017, 52(5): 86-90.
18.	Shintani Y, Okami J, Ito H, et al. Clinical features and outcomes of patients with stage Ⅰ multiple primary lung cancers. Cancer Sci, 2021, 112(5): 1924-1935.
19.	Chaft JE, Rimner A, Weder W, et al. Evolution of systemic therapy for stages Ⅰ-Ⅲ non-metastatic non-small-cell lung cancer. Nat Rev Clin Oncol, 2021, 18(9): 547-557.
20.	Liu Y, Tang Y, Xue Z, et al. SUVmax ratio on PET/CT may differentiate between lung metastases and synchronous multiple primary lung cancer. Acad Radiol, 2020, 27(5): 618-623.
21.	Dijkman BG, Schuurbiers OC, Vriens D, et al. The role of (18)F-FDG PET in the differentiation between lung metastases and synchronous second primary lung tumours. Eur J Nucl Med Mol Imaging, 2010, 37(11): 2037-2047.
22.	Wu HB, Wang L, Wang QS, et al. Adenocarcinoma with BAC features presented as the nonsolid nodule is prone to be false-negative on 18F-FDG PET/CT. Biomed Res Int, 2015, 2015: 243681.
23.	Li M, Wan Y, Zhang L, et al. Synchronous multiple lung cancers presenting as multifocal pure ground glass nodules: Are whole-body positron emission tomography/computed tomography and brain enhanced magnetic resonance imaging necessary? Transl Lung Cancer Res, 2019, 8(5): 649-657.
24.	Suh YJ, Lee HJ, Sung P, et al. A novel algorithm to differentiate between multiple primary lung cancers and intrapulmonary metastasis in multiple lung cancers with multiple pulmonary sites of involvement. J Thorac Oncol, 2020, 15(2): 203-215.
25.	周丽娜, 吴宁, 赵世俊, 等. 基于高分辨率CT特征鉴别同时多原发肺腺癌与肺腺癌伴肺内转移. 中华肿瘤杂志, 2020, 42(6): 449-455.
26.	Yotsukura M, Asamura H, Motoi N, et al. Long-term prognosis of patients with resected adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung. J Thorac Oncol, 2021, 16(8): 1312-1320.
27.	Asmar R, Sonett JR, Singh G, et al. Use of oncogenic driver mutations in staging of multiple primary lung carcinomas: A single-center experience. J Thorac Oncol, 2017, 12(10): 1524-1535.
28.	Yang Y, Yin W, He W, et al. Phenotype-genotype correlation in multiple primary lung cancer patients in China. Sci Rep, 2016, 6: 36177.
29.	Takahashi Y, Shien K, Tomida S, et al. Comparative mutational evaluation of multiple lung cancers by multiplex oncogene mutation analysis. Cancer Sci, 2018, 109(11): 3634-3642.
30.	Goodwin D, Rathi V, Conron M, et al. Genomic and clinical significance of multiple primary lung cancers as determined by next-generation sequencing. J Thorac Oncol, 2021, 16(7): 1166-1175.
31.	Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2015, 10(11): 1515-1522.
32.	Ishikawa Y, Nakayama H, Ito H, et al. Surgical treatment for synchronous primary lung adenocarcinomas. Ann Thorac Surg, 2014, 98(6): 1983-1988.
33.	郭海法, 毛锋, 张辉, 等. 同时性多原发肺癌的预后及生存相关因素研究. 中国肺癌杂志, 2017, 20(1): 21-27.

1. van der Aalst CM, Ten Haaf K, de Koning HJ. Lung cancer screening: Latest developments and unanswered questions. Lancet Respir Med, 2016, 4(9): 749-761.
2. Heuvelmans MA, Walter JE, Peters RB, et al. Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: The NELSON study. Lung Cancer, 2017, 113: 45-50.
3. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4. 张晓菊, 白莉, 金发光, 等. 肺结节诊治中国专家共识(2018年版). 中华结核和呼吸杂志, 2018, 41(10): 763-771.
5. Shimada Y, Saji H, Otani K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer, 2015, 88(2): 174-180.
6. Sato Y, Fujimoto D, Morimoto T, et al. Natural history and clinical characteristics of multiple pulmonary nodules with ground glass opacity. Respirology, 2017, 22(8): 1615-1621.
7. Chelala L, Hossain R, Kazerooni EA, et al. Lung-RADS version 1. 1: Challenges and a look ahead, from the AJR Special Series on Radiology Reporting and Data Systems. AJR Am J Roentgenol, 2021, 216(6): 1411-1422.
8. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
9. Leventakos K, Peikert T, Midthun DE, et al. Management of multifocal lung cancer: Results of a survey. J Thorac Oncol, 2017, 12(9): 1398-1402.
10. Ettinger DS, Wood DE, Aggarwal C, et al. NCCN guidelines insights: Non-small cell lung cancer, version 1. 2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
11. Galetta D, Solli P, Borri A, et al. Bilobectomy for lung cancer: Analysis of indications, postoperative results, and long-term outcomes. Ann Thorac Surg, 2012, 93(1): 251-257.
12. Yao F, Yang H, Zhao H. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules. J Thorac Dis, 2016, 8(3): 469-475.
13. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
14. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301.
15. Watanabe T, Tanahashi M, Suzuki E, et al. Surgical treatment for synchronous multiple primary lung cancer: Is it possible to achieve both curability and preservation of the pulmonary function? Thorac Cancer, 2021, 12(22): 2996-3004.
16. Ghosh S, Mehta AC, Abuquyyas S, et al. Primary lung neoplasms presenting as multiple synchronous lung nodules. Eur Respir Rev, 2020, 29(157): 190142.
17. 魏星, 刘向阳. 同时性多原发肺腺癌31例临床分析与治疗体会. 中国医刊, 2017, 52(5): 86-90.
18. Shintani Y, Okami J, Ito H, et al. Clinical features and outcomes of patients with stage Ⅰ multiple primary lung cancers. Cancer Sci, 2021, 112(5): 1924-1935.
19. Chaft JE, Rimner A, Weder W, et al. Evolution of systemic therapy for stages Ⅰ-Ⅲ non-metastatic non-small-cell lung cancer. Nat Rev Clin Oncol, 2021, 18(9): 547-557.
20. Liu Y, Tang Y, Xue Z, et al. SUVmax ratio on PET/CT may differentiate between lung metastases and synchronous multiple primary lung cancer. Acad Radiol, 2020, 27(5): 618-623.
21. Dijkman BG, Schuurbiers OC, Vriens D, et al. The role of (18)F-FDG PET in the differentiation between lung metastases and synchronous second primary lung tumours. Eur J Nucl Med Mol Imaging, 2010, 37(11): 2037-2047.
22. Wu HB, Wang L, Wang QS, et al. Adenocarcinoma with BAC features presented as the nonsolid nodule is prone to be false-negative on 18F-FDG PET/CT. Biomed Res Int, 2015, 2015: 243681.
23. Li M, Wan Y, Zhang L, et al. Synchronous multiple lung cancers presenting as multifocal pure ground glass nodules: Are whole-body positron emission tomography/computed tomography and brain enhanced magnetic resonance imaging necessary? Transl Lung Cancer Res, 2019, 8(5): 649-657.
24. Suh YJ, Lee HJ, Sung P, et al. A novel algorithm to differentiate between multiple primary lung cancers and intrapulmonary metastasis in multiple lung cancers with multiple pulmonary sites of involvement. J Thorac Oncol, 2020, 15(2): 203-215.
25. 周丽娜, 吴宁, 赵世俊, 等. 基于高分辨率CT特征鉴别同时多原发肺腺癌与肺腺癌伴肺内转移. 中华肿瘤杂志, 2020, 42(6): 449-455.
26. Yotsukura M, Asamura H, Motoi N, et al. Long-term prognosis of patients with resected adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung. J Thorac Oncol, 2021, 16(8): 1312-1320.
27. Asmar R, Sonett JR, Singh G, et al. Use of oncogenic driver mutations in staging of multiple primary lung carcinomas: A single-center experience. J Thorac Oncol, 2017, 12(10): 1524-1535.
28. Yang Y, Yin W, He W, et al. Phenotype-genotype correlation in multiple primary lung cancer patients in China. Sci Rep, 2016, 6: 36177.
29. Takahashi Y, Shien K, Tomida S, et al. Comparative mutational evaluation of multiple lung cancers by multiplex oncogene mutation analysis. Cancer Sci, 2018, 109(11): 3634-3642.
30. Goodwin D, Rathi V, Conron M, et al. Genomic and clinical significance of multiple primary lung cancers as determined by next-generation sequencing. J Thorac Oncol, 2021, 16(7): 1166-1175.
31. Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC lung cancer staging project: Proposals for the revision of the M descriptors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol, 2015, 10(11): 1515-1522.
32. Ishikawa Y, Nakayama H, Ito H, et al. Surgical treatment for synchronous primary lung adenocarcinomas. Ann Thorac Surg, 2014, 98(6): 1983-1988.
33. 郭海法, 毛锋, 张辉, 等. 同时性多原发肺癌的预后及生存相关因素研究. 中国肺癌杂志, 2017, 20(1): 21-27.

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Short-term efficacy of surgical treatment for multiple pulmonary nodules: A retrospective study in a single center

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