关键词: 多发性原发肺癌, 腺癌, 多发肺结节, 淋巴结转移

Abstract:

Objective To investigate the clinical characteristics and risk of lymph node metastasis in patients with multiple primary lung adenocarcinoma nodules compared to those with a single lung adenocarcinoma nodule. Methods Retrospective analysis was conducted on 212 patients who underwent thoracic surgery at Zhujiang Hospital of Southern Medical University from 2022 to 2023. This included 149 cases of single lung adenocarcinoma nodules and 63 cases of multiple primary lung adenocarcinoma nodules. After propensity score matching， a comparison was made between the two groups in terms of imaging features， tumor serological indicators， pathological immunohistochemistry， and lymph node metastasis rate. Additionally， binary logistic regression was employed to explore the differences in lymph node metastasis rate between single and multiple nodules. Results After propensity score matching， statistically significant differences were observed in the Avr value of CT （P = 0.001）， KI?67 expression level （P < 0.001）， PD?L1 expression level （P = 0.002）， and lymph node metastasis rate （P = 0.030） between the two groups. However， there were no statistically significant differences in nodule type， imaging features such as lobulation and vascular clustering， tumor serological indicators including CEA and NSE， ALK positive rate， and SYN positive rate. The variables with significant differences （Avr， Ki?67， PD?L1） were identified through Spearman test for correlation analysis. Binary logistic regression analysis was performed using lymph node metastasis as the dependent variable and single or multiple nodules as categorical covariates along with the three correlated variables included as independent variables interactively. The results showed that the probability of lymph node metastasis in multiple primary lung adenocarcinoma nodules was 80.8% lower than that in single lung adenocarcinoma nodules （RR = 0.192， P = 0.042）. Conclusions Multiple primary adenocarcinoma nodules exhibit a less aggressive biological behavior compared to solitary adenocarcinoma nodules， resulting in a reduced likelihood of lymph node metastasis. For cases involving multiple primary lung adenocarcinoma nodules， the implementation of aggressive surgical protocols is not advisable； instead， personalized treatment plans should be developed based on comprehensive evaluations including intraoperative frozen pathology and imaging.

Key words: multiple primary lung cancers, adenocarcinoma, multiple pulmonary nodules, lymphatic metastasis