title: Practical approach to patients presenting with multiple synchronous suspect lung lesions: a reflection on the current TNM classification based on 54 cases with complete follow-up.
abstract: OBJECTIVE
  To examine the survival after surgical treatment of patients presenting with two synchronous suspect lung lesions, and to reflect on the recent TNM classification, which has upgraded patients with two malignant lung lesions of the same histology into the T4 (both lesions in the same ipsilateral lobe) or M1 (different lobes or lungs) category.
  
  
  METHODS
  Retrieval of all consecutive patients with a diagnosis of two synchronous suspect lung lesions in the prospective database of the Leuven Lung Cancer Group in the interval between 1990 and 1994. Analysis of characteristics and survival of all patients, who underwent surgical resection with intention to cure for both lesions.
  
  
  RESULTS
  Forty-eight of 54 patients had surgical resection with curative intent. Thirty-five of these proved to have two malignant lesions, in 13 the second lesion was benign. The 5-year survival rate in the patients with two malignant lesions was 33% (95% CI: 17-49). The median survival time was 28 months. Although the number of patients in the subgroups was small, there were no obvious differences between patients with two lesions in the same or in different lobes, if a complete resection could be achieved.
  
  
  CONCLUSIONS
  An aggressive surgical approach in carefully selected patients presenting with two suspect pulmonary lesions can be rewarding. Although some degree of upstaging is appropriate in patients with two malignant lung tumours of the same histology, their current stage IIIB or IV classification probably underestimates their prospects for long-term survival after radical resection.
authors.affiliation: Respiratory Oncology Unit, Department of Pulmonology, University Hospital Gasthuisberg, Catholic University Leuven, Herestraat 49, B-3000 Leuven, Belgium. johan.vansteenkiste@uz.kuleuven.ac.be
authors.forename: J F
authors.initials: JF
authors.lastname: Vansteenkiste
authors.forename: B
authors.initials: B
authors.lastname: De Belie
authors.forename: G J
authors.initials: GJ
authors.lastname: Deneffe
authors.forename: M G
authors.initials: MG
authors.lastname: Demedts
authors.forename: P R
authors.initials: PR
authors.lastname: De Leyn
authors.forename: D E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.forename: T E
authors.initials: TE
authors.lastname: Lerut
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D018288:Carcinoma, Small Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome