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Clinicopathology and Genetic Profile of Synchronous Multiple Small Adenocarcinomas: Implication for Surgical Treatment of an Uncommon Lung Malignancy

  • Thoracic Oncology
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An Erratum to this article was published on 01 July 2014

Abstract

Purpose

Synchronous multiple small adenocarcinomas are detected more frequently than in the past; however, the genetic profile, treatment, and prognosis of patients remain unclear. For treatment decisions and prognostic applications, we evaluated epidermal growth factor receptor (EGFR), p53, and KRAS somatic mutations in synchronous multiple small lung adenocarcinomas.

Methods

The presence of EGFR, p53, and KRAS somatic mutations was determined in 64 synchronous multiple lung adenocarcinomas ≤2 cm in maximal dimension. Mutational analysis was performed on DNA extracted from paraffin-embedded tumors.

Results

Five-year disease-free survival (DFS) was 86.1 %, and overall survival was 95.8 %. EGFR, p53, and KRAS mutations were detected in 41 (64.1 %), 8 (12.5 %), and 4 (6.3 %) patients, respectively. The high frequency of genetic mutations resulted in a high discrimination rate of tumor clonality (68.8 %; 44/64) in the study group. Fourteen (31.8 %) patients were assessed as having the same clonality, whereas 30 (68.2 %) patients had different clonality, which further supported the concept of field cancerization. Multivariate analysis showed lymph node metastasis (p = 0.003) and smoking (p = 0.011) were significantly correlated with tumor relapse. Surgical method, clonality, and tumor location were not correlated with tumor relapse.

Conclusions

Whether these tumors are different or the same clonal, sublobar resection of each lesion can achieve long-term DFS and is the treatment of choice for synchronous multiple small lung adenocarcinomas. Patients with lymph node metastasis are at risk of relapse and adjuvant chemotherapy is indicated.

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Acknowledgement

The authors would like to thank Professor Yung-Chie Lee (October 23, 1948 to December 30, 2010) for his substantial contribution to patient care and surgery. This study was funded by the National Taiwan University Hospital (NTUH 100-N1713).

Conflicts of Interest

Mong-Wei Lin, Chen-Tu Wu, Shuenn-Wen Kuo, Yih-Leong Chang, and Pan-Chyr Yang declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan

    Mong-Wei Lin MD

  2. Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Chen-Tu Wu MD & Yih-Leong Chang MD

  3. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Shuenn-Wen Kuo MD

  4. Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Pan-Chyr Yang MD, PhD

  5. Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan

    Mong-Wei Lin MD, Chen-Tu Wu MD, Yih-Leong Chang MD & Pan-Chyr Yang MD, PhD

Authors
  1. Mong-Wei Lin MD
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  2. Chen-Tu Wu MD
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  3. Shuenn-Wen Kuo MD
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  4. Yih-Leong Chang MD
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Corresponding author

Correspondence to Yih-Leong Chang MD.

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Lin, MW., Wu, CT., Kuo, SW. et al. Clinicopathology and Genetic Profile of Synchronous Multiple Small Adenocarcinomas: Implication for Surgical Treatment of an Uncommon Lung Malignancy. Ann Surg Oncol 21, 2555–2562 (2014). https://doi.org/10.1245/s10434-014-3642-5

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  • DOI: https://doi.org/10.1245/s10434-014-3642-5

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