Wen J L, Wang X Y, Gu S J, Li T T, Shi L C, Kong H, Qi X
Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Department of Respiratory and Critical Care Medicine, Xuzhou Central Hospital, Xuzhou 221009, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2022 Aug 12;45(8):826-834. doi: 10.3760/cma.j.cn112147-20211209-00870.
With the application of high-resolution chest imaging system and lung cancer screening program, patients with multiple primary lung cancer (MPLC) are becoming a growing population in clinical practice. However, the diagnostic criteria of MPLC and its differentiation from intrapulmonary metastasis of lung cancer (IM) are still controversial, especially in cases with similar histology. On the basis of reviewing the existing literature, this paper discusses the changes of the diagnostic criteria of MPLC and the differential diagnosis methods of imaging, histology and molecular genetics of MPLC and IM, and briefly introduces the application of multidisciplinary diagnosis, algorithm, predictive model and artificial intelligence in the differential diagnosis of MPLC. In addition, we also discuss the latest progress in the treatment of MPLC. Radical surgery is the main method for the treatment of MPLC. Stereotactic body radiation therapy (SBRT) is safe and feasible for inoperable MPLC patients, and targeted therapy and immunotherapy can also be used in MPLC after appropriate patient selection.
随着高分辨率胸部成像系统的应用和肺癌筛查项目的开展，在临床实践中，多原发性肺癌（MPLC）患者群体日益壮大。然而，MPLC的诊断标准及其与肺癌肺内转移（IM）的鉴别仍存在争议，尤其是在组织学相似的病例中。在回顾现有文献的基础上，本文探讨了MPLC诊断标准的变化以及MPLC和IM在影像学、组织学及分子遗传学方面的鉴别诊断方法，并简要介绍了多学科诊断、算法、预测模型及人工智能在MPLC鉴别诊断中的应用。此外，我们还讨论了MPLC治疗的最新进展。根治性手术是MPLC的主要治疗方法。立体定向体部放射治疗（SBRT）对于无法手术的MPLC患者安全可行，经过适当的患者选择后，靶向治疗和免疫治疗也可用于MPLC。
