PURPOSE: Patients with pulmonary neoplasm have an increased risk for developing a second cancer of the lung –multiple primary lung cancer (MPLC) either at the same time –synchronous or at different times –metachronous.We analysed our experience to identify the clinical characteristics and to verify our surgical results and survival of our aggressive approach in patients with multiple primary lung cancer ( MPLC ).
METHODS: A total of 488 patients with primary lung cancer underwent surgical resection. We used the criteria of Martini and Melamed for the diagnosis of a synchronous and metachronous MPLC.
RESULTS: There were 35 patients (7%) with MPLC, 20 (4%) metachronous and 15 (3%) synchronous tumours. Metachronous tumours - 52.5% were squamous carcinomas, 42.5% adenocarcinomas, 2.5% large cell cancer and 2.5% mixed neuroendocrine tumours. The median interval between 1st and 2nd primary lung cancer ( PLC ) was 32 months (10 –76 months). 62% of the metachronous tumours had identical histology. Nodal status for the 1st PLC - N0, 40% N1,15% N2 disease and the 2nd PLC - 65% N0, 30% N1 and 5% N2 disease. Synchronous tumours - 59% were squamous carcinomas and 41% were adenocarcinomas. 83% of the synchronous tumours had identical histology irrespective of tumour location. . The1st MPLC Node status: N0 - 53%, N1 - 33% and N2 - 14%. The 2nd MPLC Node status: N0 - 65%, N1 - 24% and N2 - 11%. disease. Overall 5 year survival for MPLC 42.8 %, median survival 27.5 mths (1-78mths). The 30 day mortality was 2.8% (1). The 5-year survival for metachronous MPLC was 57.1%, median survival 32 mths (10-76mths). The 5-year survival for synchronous MPLC of 18.5%, median survival 23 mths ( 1-58 mths).
CONCLUSION: Surgical intervention is safe and effective in most patients with MPLC. MPLC have a more favourable prognosis than locally recurrent or metastatic disease.
CLINICAL IMPLICATIONS: Long term follow up is recommended in patients surviving curative resection to enable the early detection of a second cancer.
DISCLOSURE: Philip Curry, None.