Zhao Lishu, Liu Chaoyuan, Xie Guiyuan, Wu Fang, Hu Chunhong
Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan, People's Republic of China.
Cancer Manag Res. 2020 Oct 20;12:10361-10374. doi: 10.2147/CMAR.S268081. eCollection 2020.
With the widespread implementation of lung cancer screening, more and more patients are being diagnosed with multiple primary lung cancers (MPLCs). In the era of precision medicine, many controversies remain in differentiating MPLCs from intrapulmonary metastasis and the optimum treatment choice, especially in patients exhibiting similar histology. In this review, we summarize common diagnostic criteria and novel discrimination methods with a special emphasis on the emerging value of broad panel next-generation sequencing (NGS) for the diagnosis of MPLCs. We then discuss current advances regarding therapeutic approaches for MPLCs. Radical surgery is the main treatment modality, while stereotactic body radiotherapy (SBRT) is safe and feasible for early-stage MPLC patients with inoperable tumors. In addition, immunotherapy and targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitors, are emerging therapeutic strategies that are still in their infancy. Characteristics of both genomic profiles and tumor microenvironment are currently being evaluated but warrant further exploration to facilitate the application of targeted systematic therapies in MPLC patients.
随着肺癌筛查的广泛实施，越来越多的患者被诊断为多原发性肺癌（MPLC）。在精准医学时代，在区分MPLC与肺内转移以及最佳治疗选择方面仍存在许多争议，尤其是在组织学相似的患者中。在本综述中，我们总结了常见的诊断标准和新的鉴别方法，特别强调了全基因组二代测序（NGS）在MPLC诊断中的新兴价值。然后，我们讨论了MPLC治疗方法的当前进展。根治性手术是主要的治疗方式，而立体定向体部放疗（SBRT）对于无法手术切除肿瘤的早期MPLC患者是安全可行的。此外，免疫治疗和靶向治疗，特别是表皮生长因子受体-酪氨酸激酶抑制剂，是仍处于起步阶段的新兴治疗策略。目前正在评估基因组图谱和肿瘤微环境的特征，但仍需进一步探索，以促进靶向系统治疗在MPLC患者中的应用。
