A microsatellite is a short, repetitive sequence of DNA (usually 2 to 4 nucleotides in length). Multiple primary lung cancers (MPLC) are more than one primary lung cancer lesions arising synchronously in different locations of the same or different side of the lung. These neoplasms may have same or different histological types, but one lesion is not a metastasis from another, as each neoplasm arises independently in the lung. Abnormal microsatellite changes are closely related to the pathogenesis and development of MPLC. In this review, several aspects are discussed:①definition and origin of microsatellite; ②abnormal changes of microsatellite; ③definition and categories of MPLC; ④the influence of microsatellite on early diagnosis, treatment and prognosis of MPLC.
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.
With the changes in the disease spectrum and the advancement of examination technology, the detection rate of multiple primary lung cancers (MPLC) is gradually increasing when multiple nodules and masses in the lung are examined clinically. MPLC has significant distinction with other types of lung diseases or lung cancers in the treatment and prognosis. In most cases, patients would be recommended to undergo the surgery as soon as possible which means that the accurate diagnosis should be made before surgery or during treatment. The newly developed molecular and genomic methods are more likely to better determine the relationship between multiple lesions. Artificial intelligence can be used as a related diagnostic aid to show more accurate and objective results in the diagnosis of multiple pulmonary nodules. This review summarizes the latest MPLC diagnostic research (including pathological analysis, imaging), analyzes surgical treatment methods, and looks forward to the future research direction of MPLC diagnosis and treatment, in order to provide reference for MPLC research.
Objective To evaluate the efficacy and safety of computed tomography (CT)-guided percutaneous and cone beam CT-guided transbronchial ablation in the treatment of early multiple primary lung cancer (MPLC). Methods Retrospective analysis was performed on patients who met inclusion criteria in Shanghai Chest Hospital between May 2020 to June 2022. According to ablation pathway, lesions were divided into two groups: percutaneous ablation group and transbronchial ablation group. Results A total of 13 MPLC patients with 26 lesions were included (14 percutaneous ablation and 12 transbronchial ablation). There were no statistically significant differences in solid component, lesion location, lung field and lesion size between the two groups. The distance from the parietal pleura in the transbronchial ablation group was longer than that in percutaneous ablation group (P=0.03). The median follow-up period time were 13 months and 12 months for group percutaneous ablation and transbronchial ablation. No significant differences were found in 3-month complete ablation rate (100.0% vs. 83.3%), 1-year local control rate (100.0% vs. 91.7%) and severe complication rate (7.1% vs. 16.7%). The minor complication rate in percutaneous ablation group was higher than that in transbronchial ablation group (50.0% vs 0.0%, P=0.02). Conclusions Percutaneous ablation and transbronchial ablation have high efficacy and safety, and the latter involves lower minor complication rate. They complement each other, which provide the individualized treatments for early MPLC patients who are not suitable for or refuse surgery.
With the popularization of CT technology, more and more multiple primary lung cancer, that is, the simultaneous presence of more than one primary cancer in the lungs, has been detected. Imaging can make a rough judgment, histopathology is still the diagnostic gold standard, and molecular genetics examination can better distinguish it from intrapulmonary metastatic cancer when necessary. At present, there is no unified treatment standard for multiple primary lung cancer. Surgery is the most important and effective means, and the surgical method needs to be personalized according to the size and distribution of the patient's lesions, one-sided lobectomy and the other side sublobar resection is considered safe and feasible. At the same time, local nonsurgical treatment is also an option or a supplement to surgical treatment. This article reviews the diagnosis and treatment of multiple primary lung cancer in recent years.