title: Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management.
abstract: OBJECTIVE
  No guidelines detailing recommendations for the selection and treatment of patients with synchronous multiple primary lung cancer have been published. We report on a single-institution experience with synchronous multiple primary lung cancer, with emphasis on long-term survival.
  
  
  METHODS
  We performed a retrospective study of 125 consecutive patients with synchronous multiple primary lung cancer who underwent operation between 1985 and 2006. Various treatment strategies were applied, including perioperative therapy. Potential prognosticators were submitted to univariate and multivariate analyses.
  
  
  RESULTS
  Tumors were bilateral (n = 34) or ipsilateral (n = 91). Optimal surgical treatment (complete anatomic resection with radical lymphadenectomy) was possible in 65.6% of the cases. pN0 disease was present in 32.3% of the patients; 30-day and 90-day mortality rates were 4.5% and 11%, respectively. Two- and 5-year overall survivals were 61.6% and 34%, respectively, with a median survival of 35 months. On univariate analysis, smoking status, high Charlson index, low forced expiratory volume in 1 second, occurrence of postoperative complications, and performance of a pneumonectomy affected the overall survival adversely. Conversely, bilateral disease, location in the same lobe, and pN0 disease were favorable prognosticators. On multivariate analysis, low forced expiratory volume in 1 second, nonoptimal surgical treatment, and performance of a pneumonectomy were independent predictors of poor long-term survival, whereas female sex, younger age, asymptomatic disease, pN0 status, and performance of an adjuvant treatment affected the survival favorably.
  
  
  CONCLUSIONS
  Provided there is an appropriate selection process, patients with synchronous multiple primary lung cancer are expected to benefit from surgery. Optimal surgery should be performed, but pneumonectomy should be avoided whenever possible. Adjuvant treatment is suggested to provide an added survival advantage.
authors.affiliation: Department of Thoracic Surgery, Sainte Marguerite University Hospital, Marseille, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Trousse
authors.forename: Fabrice
authors.initials: F
authors.lastname: Barlesi
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Tasei
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Roger
authors.initials: R
authors.lastname: Giudicelli
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
authors.forename: Pierre
authors.initials: P
authors.lastname: Fuentes
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy; D015996:Survival Rate