Research progress in diagnosis and treatment of multiple primary lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Qinling , HUANG Yunchao , ZHAO Guangqiang ,  YE Lianhua

Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, 650000, P.R.China;

Corresponding author：

YE Lianhua, Email: Lhye1204@aliyun.com

Keywords：

Multiple primary lung cancer; diagnosis; treatment; review

DOI：

10.7507/1007-4848.202010094

Video：

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Abstract Full text Figures/Tables Video References Cited by

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.

Citation： SUN Qinling, HUANG Yunchao, ZHAO Guangqiang, YE Lianhua. Research progress in diagnosis and treatment of multiple primary lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(1): 127-132. doi: 10.7507/1007-4848.202010094 Copy

1.	Beyreuther H. Multiplicität von Carcinomen bei einem Fall von sog. "Schneeberger" Lungenkrebs mit Tuberkulose, 1924, 250(1-2): 230-243.
2.	Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
3.	陈亚男, 滑炎卿. 多原发肺癌HRCT影像特点及其临床意义的研究进展. 国际医学放射学杂志, 2018, 41(2): 175-179.
4.	陈海泉. 多原发非小细胞肺癌的诊断与外科治疗进展. 中华胸部外科电子杂志, 2014, 1(1): 3-7.
5.	Yu YC, Hsu PK, Yeh YC, et al. Surgical results of synchronous multiple primary lung cancers: Similar to the stage-matched solitary primary lung cancers? Ann Thorac Surg, 2013, 96(6): 1966-1974.
6.	Yang J, Liu M, Fan J, et al. Surgical treatment of metachronous second primary lung cancer. Ann Thorac Surg, 2014, 98(4): 1192-1198.
7.	De Leyn P, Moons J, Vansteenkiste J, et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg, 2008, 34(6): 1215-1222.
8.	Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
9.	Tsunezuka Y, Matsumoto I, Tamura M, et al. The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre. Eur J Surg Oncol, 2004, 30(7): 781-785.
10.	Toufektzian L, Attia R, Veres L. Does the extent of resection affect survival in patients with synchronous multiple primary lung cancers undergoing curative surgery? Interact Cardiovasc Thorac Surg, 2014, 19(6): 1059-1064.
11.	Zuin A, Andriolo LG, Marulli G, et al. Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer? Eur J Cardiothorac Surg, 2013, 44(2): e120-e125.
12.	Fonseca A, Detterbeck FC. How many names for a rose: Inconsistent classification of multiple foci of lung cancer due to ambiguous rules. Lung Cancer, 2014, 85(1): 7-11.
13.	韩连奎, 高树庚, 谭锋维, 等. 同时性多原发肺癌的诊治体会及处理策略新进展. 中国肺癌杂志, 2018, 21(3): 180-184.
14.	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.
15.	Kosaka N, Tsuchida T, Tsuji K, et al. Standardized uptake value differences between primary and metastatic lesions in ¹⁸F-FDG PET/CT of patients with lung cancer. Acta Radiol, 2015, 56(11): 1329-1335.
16.	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.
17.	Liu C, Ma L, Lin F, et al. Single-staged uniportal VATS major pulmonary resection for bilateral synchronous multiple primary lung cancers. J Thorac Dis, 2014, 6(9): 1315-1318.
18.	虞桂平, 单一波, 黄斌, 等. 术前CT引导Hook-wire定位同时性多原发性肺癌的诊疗价值. 中国医药导报, 2019, (11): 81-84.
19.	Kozower BD, Larner JM, Detterbeck FC, et al. Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e369S-e399S.
20.	Detterbeck FC, Jones DR, Kernstine KH, et al. Lung cancer. Special treatment issues. Chest, 2003, 123(1 Suppl): 244S-258S.
21.	Mun M, Kohno T. Single-stage surgical treatment of synchronous bilateral multiple lung cancers. Ann Thorac Surg, 2007, 83(3): 1146-1151.
22.	Shen C, Wang X, Tian L, et al. "Different trend" in multiple primary lung cancer and intrapulmonary metastasis. Eur J Med Res, 2015, 20(1): 17.
23.	Pasic A, Vonk-Noordegraaf A, Risse EK, et al. Multiple suspicious lesions detected by autofluorescence bronchoscopy predict malignant development in the bronchial mucosa in high risk patients. Lung Cancer, 2003, 41(3): 295-301.
24.	van Rens MT, Zanen P, Brutel de La Rivière A, et al. Survival in synchronous vs. single lung cancer: Upstaging better reflects prognosis. Chest, 2000, 118(4): 952-958.
25.	Hanahan D, Weinberg RA. The hallmarks of cancer. Cell, 2000, 100(1): 57-70.
26.	Ono K, Sugio K, Uramoto H, et al. Discrimination of multiple primary lung cancers from intrapulmonary metastasis based on the expression of four cancer-related proteins. Cancer, 2009, 115(15): 3489-3500.
27.	Chen D, Mei L, Zhou Y, et al. A novel differential diagnostic model for multiple primary lung cancer: Differentially-expressed gene analysis of multiple primary lung cancer and intrapulmonary metastasis. Oncol Lett, 2015, 9(3): 1081-1088.
28.	Hammerman PS, Sos ML, Ramos AH, et al. Mutations in the DDR2 kinase gene identify a novel therapeutic target in squamous cell lung cancer. Cancer Discov, 2011, 1(1): 78-89.
29.	Eberhard DA, Johnson BE, Amler LC, et al. Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol, 2005, 23(25): 5900-5909.
30.	Jin G, Jeon HS, Lee EB, et al. EML4-ALK fusion gene in Korean non-small cell lung cancer. J Korean Med Sci, 2012, 27(2): 228-230.
31.	Takeuchi K, Soda M, Togashi Y, et al. RET, ROS1 and ALK fusions in lung cancer. Nat Med, 2012, 18(3): 378-381.
32.	Fukui T, Yatabe Y, Kobayashi Y, et al. Clinicoradiologic characteristics of patients with lung adenocarcinoma harboring EML4-ALK fusion oncogene. Lung Cancer, 2012, 77(2): 319-325.
33.	Wang L, Hu H, Pan Y, et al. PIK3CA mutations frequently coexist with EGFR/KRAS mutations in non-small cell lung cancer and suggest poor prognosis in EGFR/KRAS wildtype subgroup. PLoS One, 2014, 9(2): e88291.
34.	Mogi A, Kuwano H. TP53 mutations in nonsmall cell lung cancer. J Biomed Biotechnol, 2011, 2011: 583929.
35.	Kristiansen G, Yu Y, Petersen S, et al. Overexpression of c-erbB2 protein correlates with disease-stage and chromosomal gain at the c-erbB2 locus in non-small cell lung cancer. Eur J Cancer, 2001, 37(9): 1089-1095.
36.	Turken O, Kunter E, Cermik H, et al. Prevalence and prognostic value of c-erbB2 expression in non-small cell lung cancer (NSCLC). Neoplasma, 2003, 50(4): 257-261.
37.	鲍轶, 莫娟芬. 高通量测序在多原发肺癌的诊断及解码肺癌进化的价值. 医学研究杂志, 2019, 48(7): 168-170.
38.	Del Vecchio F, Mastroiaco V, Di Marco A, et al. Next-generation sequencing: Recent applications to the analysis of colorectal cancer. J Transl Med, 2017, 15(1): 246.
39.	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.
40.	Patel SB, Kadi W, Walts AE, et al. Next-generation sequencing: A novel approach to distinguish multifocal primary lung adenocarcinomas from intrapulmonary metastases. J Mol Diagn, 2017, 19(6): 870-880.
41.	Saab J, Zia H, Mathew S, et al. Utility of genomic analysis in differentiating synchronous and metachronous lung adenocarcinomas from primary adenocarcinomas with intrapulmonary metastasis. Transl Oncol, 2017, 10(3): 442-449.
42.	Donfrancesco E, Yvorel V, Casteillo F, et al. Histopathological and molecular study for synchronous lung adenocarcinoma staging. Virchows Arch, 2020, 476(6): 835-842.
43.	Rami-Porta R, Asamura H, Travis WD, et al. Lung cancer — major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(2): 138-155.
44.	Riquet M, Cazes A, Pfeuty K, et al. Multiple lung cancers prognosis: What about histology? Ann Thorac Surg, 2008, 86(3): 921-926.
45.	Hamaji M, Allen MS, Cassivi SD, et al. Surgical treatment of metachronous second primary lung cancer after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2013, 145(3): 683-690.
46.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
47.	Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
48.	Lee BE, Port JL, Stiles BM, et al. TNM stage is the most important determinant of survival in metachronous lung cancer. Ann Thorac Surg, 2009, 88(4): 1100-1105.
49.	Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
50.	Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival?: A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. J Thorac Oncol, 2011, 6(9): 1496-1504.
51.	Lococo F, Cesario A, Leuzzi G, et al. Second primary non-small-cell lung cancer: Implications of the new adenocarcinoma classification in the challenging decision of the best surgical strategy. Eur J Cardiothorac Surg, 2014, 45(6): 1115-1116.
52.	Renaud S, Falcoz PE, Olland A, et al. Is radiofrequency ablation or stereotactic ablative radiotherapy the best treatment for radically treatable primary lung cancer unfit for surgery? Interact Cardiovasc Thorac Surg, 2013, 16(1): 68-73.
53.	Jahangeer S, Forde P, Soden D, et al. Review of current thermal ablation treatment for lung cancer and the potential of electrochemotherapy as a means for treatment of lung tumours. Cancer Treat Rev, 2013, 39(8): 862-871.
54.	Welborn SL, Ohori NP, Nason KS, et al. Percutaneous computed tomography-guided biopsy performed by thoracic surgeons in 955 patients: A paradigm shift in image-guided thoracic procedures. J Thorac Cardiovasc Surg, 2019, 157(3): 1239-1245.
55.	Teng J, Xu J, Jiao J, et al. Radiofrequency ablation of synchronous multiple primary lung cancer assisted by a magnetic navigation system: A case report. Ann Palliat Med, 2020, 9(2): 478-482.
56.	Li X, Hu B, Li H, et al. Application of artificial intelligence in the diagnosis of multiple primary lung cancer. Thorac Cancer, 2019, 10(11): 2168-2174.
57.	Li J, Yang X, Xia T, et al. Stage Ⅰ synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis. J Thorac Dis, 2017, 9(12): 5335-5344.
58.	刘伦旭, 高树庚, 何建行, 等. 非小细胞肺癌术后随访中国胸外科专家共识. 中国胸心血管外科临床杂志, 2021, 28(1): 4-10.

1. Beyreuther H. Multiplicität von Carcinomen bei einem Fall von sog. "Schneeberger" Lungenkrebs mit Tuberkulose, 1924, 250(1-2): 230-243.
2. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg, 1975, 70(4): 606-612.
3. 陈亚男, 滑炎卿. 多原发肺癌HRCT影像特点及其临床意义的研究进展. 国际医学放射学杂志, 2018, 41(2): 175-179.
4. 陈海泉. 多原发非小细胞肺癌的诊断与外科治疗进展. 中华胸部外科电子杂志, 2014, 1(1): 3-7.
5. Yu YC, Hsu PK, Yeh YC, et al. Surgical results of synchronous multiple primary lung cancers: Similar to the stage-matched solitary primary lung cancers? Ann Thorac Surg, 2013, 96(6): 1966-1974.
6. Yang J, Liu M, Fan J, et al. Surgical treatment of metachronous second primary lung cancer. Ann Thorac Surg, 2014, 98(4): 1192-1198.
7. De Leyn P, Moons J, Vansteenkiste J, et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg, 2008, 34(6): 1215-1222.
8. Kocaturk CI, Gunluoglu MZ, Cansever L, et al. Survival and prognostic factors in surgically resected synchronous multiple primary lung cancers. Eur J Cardiothorac Surg, 2011, 39(2): 160-166.
9. Tsunezuka Y, Matsumoto I, Tamura M, et al. The results of therapy for bilateral multiple primary lung cancers: 30 years experience in a single centre. Eur J Surg Oncol, 2004, 30(7): 781-785.
10. Toufektzian L, Attia R, Veres L. Does the extent of resection affect survival in patients with synchronous multiple primary lung cancers undergoing curative surgery? Interact Cardiovasc Thorac Surg, 2014, 19(6): 1059-1064.
11. Zuin A, Andriolo LG, Marulli G, et al. Is lobectomy really more effective than sublobar resection in the surgical treatment of second primary lung cancer? Eur J Cardiothorac Surg, 2013, 44(2): e120-e125.
12. Fonseca A, Detterbeck FC. How many names for a rose: Inconsistent classification of multiple foci of lung cancer due to ambiguous rules. Lung Cancer, 2014, 85(1): 7-11.
13. 韩连奎, 高树庚, 谭锋维, 等. 同时性多原发肺癌的诊治体会及处理策略新进展. 中国肺癌杂志, 2018, 21(3): 180-184.
14. 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.
15. Kosaka N, Tsuchida T, Tsuji K, et al. Standardized uptake value differences between primary and metastatic lesions in ¹⁸F-FDG PET/CT of patients with lung cancer. Acta Radiol, 2015, 56(11): 1329-1335.
16. 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.
17. Liu C, Ma L, Lin F, et al. Single-staged uniportal VATS major pulmonary resection for bilateral synchronous multiple primary lung cancers. J Thorac Dis, 2014, 6(9): 1315-1318.
18. 虞桂平, 单一波, 黄斌, 等. 术前CT引导Hook-wire定位同时性多原发性肺癌的诊疗价值. 中国医药导报, 2019, (11): 81-84.
19. Kozower BD, Larner JM, Detterbeck FC, et al. Special treatment issues in non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e369S-e399S.
20. Detterbeck FC, Jones DR, Kernstine KH, et al. Lung cancer. Special treatment issues. Chest, 2003, 123(1 Suppl): 244S-258S.
21. Mun M, Kohno T. Single-stage surgical treatment of synchronous bilateral multiple lung cancers. Ann Thorac Surg, 2007, 83(3): 1146-1151.
22. Shen C, Wang X, Tian L, et al. "Different trend" in multiple primary lung cancer and intrapulmonary metastasis. Eur J Med Res, 2015, 20(1): 17.
23. Pasic A, Vonk-Noordegraaf A, Risse EK, et al. Multiple suspicious lesions detected by autofluorescence bronchoscopy predict malignant development in the bronchial mucosa in high risk patients. Lung Cancer, 2003, 41(3): 295-301.
24. van Rens MT, Zanen P, Brutel de La Rivière A, et al. Survival in synchronous vs. single lung cancer: Upstaging better reflects prognosis. Chest, 2000, 118(4): 952-958.
25. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell, 2000, 100(1): 57-70.
26. Ono K, Sugio K, Uramoto H, et al. Discrimination of multiple primary lung cancers from intrapulmonary metastasis based on the expression of four cancer-related proteins. Cancer, 2009, 115(15): 3489-3500.
27. Chen D, Mei L, Zhou Y, et al. A novel differential diagnostic model for multiple primary lung cancer: Differentially-expressed gene analysis of multiple primary lung cancer and intrapulmonary metastasis. Oncol Lett, 2015, 9(3): 1081-1088.
28. Hammerman PS, Sos ML, Ramos AH, et al. Mutations in the DDR2 kinase gene identify a novel therapeutic target in squamous cell lung cancer. Cancer Discov, 2011, 1(1): 78-89.
29. Eberhard DA, Johnson BE, Amler LC, et al. Mutations in the epidermal growth factor receptor and in KRAS are predictive and prognostic indicators in patients with non-small-cell lung cancer treated with chemotherapy alone and in combination with erlotinib. J Clin Oncol, 2005, 23(25): 5900-5909.
30. Jin G, Jeon HS, Lee EB, et al. EML4-ALK fusion gene in Korean non-small cell lung cancer. J Korean Med Sci, 2012, 27(2): 228-230.
31. Takeuchi K, Soda M, Togashi Y, et al. RET, ROS1 and ALK fusions in lung cancer. Nat Med, 2012, 18(3): 378-381.
32. Fukui T, Yatabe Y, Kobayashi Y, et al. Clinicoradiologic characteristics of patients with lung adenocarcinoma harboring EML4-ALK fusion oncogene. Lung Cancer, 2012, 77(2): 319-325.
33. Wang L, Hu H, Pan Y, et al. PIK3CA mutations frequently coexist with EGFR/KRAS mutations in non-small cell lung cancer and suggest poor prognosis in EGFR/KRAS wildtype subgroup. PLoS One, 2014, 9(2): e88291.
34. Mogi A, Kuwano H. TP53 mutations in nonsmall cell lung cancer. J Biomed Biotechnol, 2011, 2011: 583929.
35. Kristiansen G, Yu Y, Petersen S, et al. Overexpression of c-erbB2 protein correlates with disease-stage and chromosomal gain at the c-erbB2 locus in non-small cell lung cancer. Eur J Cancer, 2001, 37(9): 1089-1095.
36. Turken O, Kunter E, Cermik H, et al. Prevalence and prognostic value of c-erbB2 expression in non-small cell lung cancer (NSCLC). Neoplasma, 2003, 50(4): 257-261.
37. 鲍轶, 莫娟芬. 高通量测序在多原发肺癌的诊断及解码肺癌进化的价值. 医学研究杂志, 2019, 48(7): 168-170.
38. Del Vecchio F, Mastroiaco V, Di Marco A, et al. Next-generation sequencing: Recent applications to the analysis of colorectal cancer. J Transl Med, 2017, 15(1): 246.
39. 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.
40. Patel SB, Kadi W, Walts AE, et al. Next-generation sequencing: A novel approach to distinguish multifocal primary lung adenocarcinomas from intrapulmonary metastases. J Mol Diagn, 2017, 19(6): 870-880.
41. Saab J, Zia H, Mathew S, et al. Utility of genomic analysis in differentiating synchronous and metachronous lung adenocarcinomas from primary adenocarcinomas with intrapulmonary metastasis. Transl Oncol, 2017, 10(3): 442-449.
42. Donfrancesco E, Yvorel V, Casteillo F, et al. Histopathological and molecular study for synchronous lung adenocarcinoma staging. Virchows Arch, 2020, 476(6): 835-842.
43. Rami-Porta R, Asamura H, Travis WD, et al. Lung cancer — major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(2): 138-155.
44. Riquet M, Cazes A, Pfeuty K, et al. Multiple lung cancers prognosis: What about histology? Ann Thorac Surg, 2008, 86(3): 921-926.
45. Hamaji M, Allen MS, Cassivi SD, et al. Surgical treatment of metachronous second primary lung cancer after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg, 2013, 145(3): 683-690.
46. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
47. Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
48. Lee BE, Port JL, Stiles BM, et al. TNM stage is the most important determinant of survival in metachronous lung cancer. Ann Thorac Surg, 2009, 88(4): 1100-1105.
49. Travis WD, Brambilla E, Noguchi M, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol, 2011, 6(2): 244-285.
50. Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival?: A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification. J Thorac Oncol, 2011, 6(9): 1496-1504.
51. Lococo F, Cesario A, Leuzzi G, et al. Second primary non-small-cell lung cancer: Implications of the new adenocarcinoma classification in the challenging decision of the best surgical strategy. Eur J Cardiothorac Surg, 2014, 45(6): 1115-1116.
52. Renaud S, Falcoz PE, Olland A, et al. Is radiofrequency ablation or stereotactic ablative radiotherapy the best treatment for radically treatable primary lung cancer unfit for surgery? Interact Cardiovasc Thorac Surg, 2013, 16(1): 68-73.
53. Jahangeer S, Forde P, Soden D, et al. Review of current thermal ablation treatment for lung cancer and the potential of electrochemotherapy as a means for treatment of lung tumours. Cancer Treat Rev, 2013, 39(8): 862-871.
54. Welborn SL, Ohori NP, Nason KS, et al. Percutaneous computed tomography-guided biopsy performed by thoracic surgeons in 955 patients: A paradigm shift in image-guided thoracic procedures. J Thorac Cardiovasc Surg, 2019, 157(3): 1239-1245.
55. Teng J, Xu J, Jiao J, et al. Radiofrequency ablation of synchronous multiple primary lung cancer assisted by a magnetic navigation system: A case report. Ann Palliat Med, 2020, 9(2): 478-482.
56. Li X, Hu B, Li H, et al. Application of artificial intelligence in the diagnosis of multiple primary lung cancer. Thorac Cancer, 2019, 10(11): 2168-2174.
57. Li J, Yang X, Xia T, et al. Stage Ⅰ synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis. J Thorac Dis, 2017, 9(12): 5335-5344.
58. 刘伦旭, 高树庚, 何建行, 等. 非小细胞肺癌术后随访中国胸外科专家共识. 中国胸心血管外科临床杂志, 2021, 28(1): 4-10.

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Research progress in diagnosis and treatment of multiple primary lung cancer

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