title: SUVmax and Tumor Size Predict Surgical Outcome of Synchronous Multiple Primary Lung Cancers.
abstract: To assess surgical outcomes in synchronous multiple primary lung cancer (SMPLC) and correlations with clinicopathological features and prognostic/predictive factors.We retrospectively reviewed patients diagnosed with early-stage nonsmall cell lung cancer (NSCLC) between January 2006 and June 2012. In total, 564 patients with resectable NSCLC underwent a preoperative positron emission tomography-computed tomography scan followed by anatomic resection. We reviewed the clinical features of 35 SMPLC patients. Surgical outcomes, prognosis, and tumor imaging features were evaluated (median follow-up = 44 months).In total, 35 eligible SMPLC patients (6.21%) were identified (11 men [31%], 24 women [69%], mean age = 65 years]). The tumors were bilateral in 17 patients (49%) and in different lobes of the ipsilateral lung in 18 patients (51%). Most patients (26/35, 74%) had 2 primary tumors, and 26% (9/35) had more than 2 tumors (6 with 3 tumors; 3 with 4 tumors). The median size of the most advanced tumor was 3.0 cm (range 0.9-54). The median standard uptake value (SUV) of the largest tumor was 3.1 (range 1.0-13.3). The patients were treated as follows: 30 lobectomies, 2 sublobar resections, 2 sequential bilateral lobectomies, and 1 bi-lobectomy. Twenty-four patients (69%) received adjuvant therapy. The overall cumulative 5-year survival was 91.5% (median overall survival = 45.5 months). Patients with a reference tumor ≤ 3 cm and SUV ≤ 3.1 had an expected 5-year survival of 100%. Patients with a reference tumor > 3 cm and SUV > 3.1 had an expected 5-year survival rate of 53.3%.SMPLC patients can benefit from aggressive surgery. The size and SUVmax of the reference tumor may predict postoperative outcomes.
authors.affiliation: From the Department of Radiology (H-HH, K-HK), Department of Nuclear Medicine (L-FL), Department of Pathology (W-CT), and Division of Thoracic Surgery, Department of Surgery (T-WH, S-CL, HC), Tri-Service General Hospital and National Defense Medical Center, China; Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University (Y-CC), Taipei, Taiwan, China.
authors.forename: Hsian-He
authors.initials: HH
authors.lastname: Hsu
authors.forename: Kai-Hsiung
authors.initials: KH
authors.lastname: Ko
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chou
authors.forename: Lin-Fan
authors.initials: LF
authors.lastname: Lin
authors.forename: Wen-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.forename: Shih-Chun
authors.initials: SC
authors.lastname: Lee
authors.forename: Hung
authors.initials: H
authors.lastname: Chang
authors.forename: Tsai-Wang
authors.initials: TW
authors.lastname: Huang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D011013:Pneumonectomy / Q000401:mortality; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed