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The Annals of Thoracic Surgery, Vol 52, 773-778, Copyright © 1991 by The Society of Thoracic Surgeons
TK Rosengart, N Martini, P Ghosn and M Burt
From 1955 to 1990, 111 patients have been treated for multiple primary lung
carcinomas. Criteria for diagnosis were: (1) different histology (n = 44);
or (2) same histology, but disease-free interval at least 2 years (n = 39),
origin from carcinoma in situ (n = 19), or metachronous disease in
different lobe (n = 9) with no cancer in common lymphatics or
extrapulmonary metastasis at the time of diagnosis. The second cancer was
synchronous in 33 patients (30%) and metachronous in 78 (70%). Metachronous
disease developed at a median interval of 48 months. Five-year survival for
patients with metachronous and synchronous disease from the time of initial
diagnosis of cancer was 70% and 44%, and 10-year survival was 42% and 23%,
respectively. Survival after the development of a metachronous lesion was
23% at 5 years. Survival from the time of initial diagnosis was
significantly better for metachronous versus synchronous, late (24 month
disease-free interval) versus early metachronous disease, and
adenocarcinoma versus epidermoid carcinoma. The first cancer was completely
resected in 103 patients (93%), but complete resection of a metachronous
tumor was possible in only 54 patients (69%). Complete resection of second
primary cancers resulted in significantly (p less than 0.0001) prolonged
5-year survival compared with incomplete resection (38% versus 9%).
Excluding patients requiring pneumonectomy, initial resection limited
subsequent resection in only 7 patients (9%) with metachronous disease. We
conclude that patients surviving treatment of primary lung cancers require
lifelong screening for multiple primary lung carcinoma, and complete
resection is recommended whenever possible.
ARTICLES
Multiple primary lung carcinomas: prognosis and treatment
Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York 10021.
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