多原发肺癌临床诊治进展

Progress in clinical diagnosis and treatment of multiple primary lung cancer

随着高分辨率胸部影像系统和肺癌筛查程序的应用,多原发肺癌(multiple primary lung cancer,MPLC)患者正成为临床实践中日益增长的人群。但是,MPLC诊断标准及其与肺癌肺内转移(intrapulmonary metastasis,IM)之间的鉴别仍然存在许多争议,特别是在组织学相似的病例中。本文在回顾现有文献的基础上,讨论了MPLC诊断标准的变化以及MPLC与IM的影像学、组织学和分子遗传学的鉴别诊断方法,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,我们还讨论了关于MPLC治疗方法的最新进展。根治性手术是治疗MPLC的主要手段,立体定向放疗(stereotactic body radiation therapy,SBRT)对不能手术的MPLC患者是安全可行的,而靶向治疗和免疫治疗经过合适的患者选择也可以应用于MPLC。

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.