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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2020

01-06-2020 | Computed Tomography | Thoracic Oncology

Imaging Features Suggestive of Multiple Primary Lung Adenocarcinomas

Authors: Yiliang Zhang, MD, PhD, Guodong Li, MD, Yuan Li, MD, PhD, Quan Liu, MD, Yongfu Yu, PhD, Yuan Ma, PhD, Yunjian Pan, MD, Yang Zhang, MD, Hong Hu, MD, Yihua Sun, MD, Yawei Zhang, MD, Jiaqing Xiang, MD, Haiquan Chen, MD

Published in: Annals of Surgical Oncology | Issue 6/2020

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Abstract

Background

The tumor-node-metastasis classification system has proposed that lung cancers presenting as multifocal ground-glass nodules (multi-GGN) on computed tomography scan should be staged as multiple primaries instead of intrapulmonary metastases. However, the problem still exists for those synchronous multiple lung adenocarcinomas (SMLA) involving solid lesions. This study aimed to explore the distinct features of SMLA to better define the diagnosis and staging of this disease.

Methods

Between 2008 and 2016, consecutive patients with complete resection of SMLA were prospectively enrolled in the study. The patients were divided into three groups based on CT images as follows: multi-GGN, one solid nodule plus one or more GGNs (solid-GGN), and multiple solid lesions with or without GGN (multi-solid). Clinicopathologic features and survival outcomes were compared between these groups. Multivariate Cox proportional hazards analyses using bootstrap internal validation were performed to identify independent predictors for recurrence-free survival (RFS) and overall survival (OS).

Results

Of the 695 patients who met the inclusion criteria, 486 (69.9%) presented with multi-GGN tumor, 124 (17.9%) with solid-GGN tumor, and 85 (12.2%) with multi-solid tumor. The three groups had distinguished clinicopathologic features of gender, smoking history, nodal metastases, tumor size, subtype, and location (all P < 0.001). Multivariate analyses demonstrated that multi-solid tumor was an independent predictor for both decreased RFS [hazard ratio (HR) 2.941; 95% confidence interval (CI) 1.07–8.08; P = 0.036] and poor OS (HR 6.13; 95% CI 1.15–32.63; P = 0.034), but neither RFS (P = 0.384) nor OS (P = 0.811) differed between solid-GGN and multi-GGN tumors.

Conclusions

Both multi-GGN and solid-GGN tumors should be staged as multiple primaries, whereas multi-solid tumor was indicated to be advanced disease.
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Metadata
Title
Imaging Features Suggestive of Multiple Primary Lung Adenocarcinomas
Authors
Yiliang Zhang, MD, PhD
Guodong Li, MD
Yuan Li, MD, PhD
Quan Liu, MD
Yongfu Yu, PhD
Yuan Ma, PhD
Yunjian Pan, MD
Yang Zhang, MD
Hong Hu, MD
Yihua Sun, MD
Yawei Zhang, MD
Jiaqing Xiang, MD
Haiquan Chen, MD
Publication date
01-06-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-08109-w

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