The incidence of malignant gastrointestinal (GI) tumors is increasing, and advancements in medical care have significantly improved patient survival rates. As a result, the number of cases involving multiple primary cancers (MPC) has also increased. The rarity of MPC and the absence of sensitive and specific diagnostic markers often lead to missed or incorrect diagnoses. It is, therefore, of vital importance to improve the vigilance of clinicians and the accurate diagnosis of this disease. Patients with GI malignancies face a higher relative risk of developing additional primary malignant tumors compared to those with other systemic tumors. Vigilant monitoring and follow-up are crucial, especially for high-risk groups, which include older adults, men, those with addictions to alcohol and tobacco, those with a family history of tumors, and those who have undergone radiotherapy.

In this article, we report three cases of MPC, each involving malignant tumors of the GI tract as the initial primary carcinoma, offering insights that may aid in effectively managing similar cases.

Patients with GI malignancies face a higher MPC risk. Developing screening and follow-up protocols may enhance detection and treatment outcomes.

• Multiple primary cancer
• Gastrointestinal tract
• Synchronous
• Metachronous
• Case report

• Lung squamous cell carcinoma
• MALT
• Pathology
• Prognosis

• Meta-analysis
• Prognosis
• Second primary lung cancer
• Surgery

• No.81860325 National Natural Science Foundation of China
• NO. 202201AY070001-135 Yunnan Fundamental Research Projects

Multiple primary lung cancer (MPLC) is considered relatively rare. This report presents an unusual case of multiple pulmonary nodules in a 74-year-old man who presented with three independent synchronous tumors in the right upper lobe. The tumors were diagnosed as peripheral squamous cell carcinoma (SCC), adenocarcinoma, and pulmonary mixed squamous cell and glandular papilloma (mixed papilloma). Mixed papilloma is an extremely rare, benign pulmonary tumor with a typical papillary appearance, showing squamous and glandular epithelial differentiation. The histological and immunohistochemical features of each tumor were analyzed. In addition, molecular pathological examination for epidermal growth factor receptor (EGFR) showed no mutation in two primary cancers. Mixed papilloma showed no BRAF V600E mutation or HPV infection. The present case report provides a clinicopathological understanding of an instance in which three tumors of different pathological types are present in the same lung lobe. Furthermore, it provides a literature review regarding multiple lung nodules, focusing on the clinicopathological diagnosis, clinical treatment, and prognostic assessment of these nodules. This is the first case report of mixed papilloma arising in MPLC.

• adenocarcinoma
• mixed squamous cell and glandular papilloma
• multiple lung nodules
• multiple primary lung cancer
• squamous

• Follow-up
• Guidelines
• Lung cancer
• Metachronous
• Surgery
• Synchronous

• Carcinoma, Non-Small-Cell Lung/surgery
• Humans
• Lung
• Lung Neoplasms/surgery
• Neoplasms, Multiple Primary
• Neoplasms, Second Primary

• Intrapulmonary metastasis
• Multifocal lung cancer
• Multiple primary lung cancer
• Next generation sequencing
• Non–small cell lung cancer

• graft-versus-host disease
• hematopoietic cell transplantation
• immune state
• multiple primary carcinomas
• p53

• MPLCs
• SBRT
• diagnosis
• immunotherapy
• multiple primary lung cancers
• stereotactic body radiation therapy
• surgery
• targeted therapy

Patients who have previously undergone surgical resection of initial primary lung cancer (IPLC) are at high risk of developing second primary lung cancer (SPLC). There are still no standard treatments for SPLC. This study aimed to identify the prognostic factors and compare survival between the different SPLC treatment groups.

SPLC patients in the Surveillance, Epidemiology, and End Results (SEER) database between 2007 and 2016 were retrospectively reviewed. Prognostic factors for SPLC were identified, using the least absolute shrinkage and selection operator (LASSO) regression and univariate Cox analysis to select variables for multivariate Cox analysis. Kaplan‐Meier method plus log‐rank test and restricted mean survival time (RMST) were used to compare survival outcome.

A total of 665 SPLC patients were finally enrolled into the study. Multivariate Cox regression analysis revealed that male vs. female (HR = 1.82, 95% CI: 1.29–2.59, P = 0.001), tumor size of SPLC ≥1 cm vs. <1 cm (HR = 1.80, 96% CI: 1.07–3.02, P = 1.028), IPLC characteristics of squamous cell carcinoma vs. adenocarcinoma (HR = 1.89, 95% CI: 1.17–3.04, P = 0.009), clinical stage II vs. stage I (HR = 2.60, 95% CI: 1.08–6.27, P = 0.033), and T2 stage vs. T1 stage (HR = 1.68, 95% CI: 1.04–2.72, P = 0.034) indicated worse survival. SPLC patients demonstrated a five‐year survival rate of 68.6% and a five‐year RMST of 49.4 months. The choice of surgical procedure (wedge resection, segmentectomy and lobectomy) for both IPLC and SPLC had no significant effect on prognosis (P > 0.05). Patients that received radiotherapy for SPLC also demonstrated similar survival when compared with those that underwent surgery (P > 0.05).

Radiotherapy and sublobar resection can be considered reasonable alternative treatments for SPLC, especially when patients are unable to tolerate lobectomy.

• LASSO regression
• non-small cell lung cancer
• second primary lung cancer
• survival analysis

There is an increasing incidence rate of ground-glass opacity (GGO), especially for multiple GGOs (≥2). Whether it is safe and feasible to have bilateral simultaneous surgical resection remains unknown. The purpose of this study is to summarize the experience of surgical resection of patients with multiple GGOs in our Hospital in recent years, and to discuss the above questions.

Clinical datas of patients who underwent one-stage bilateral uni-portal VATS resections of multiple pulmonary ground glass opacities and had routine pathological examination were collected from May 2016 to May 2019 in our hospital.

A total of 34 patients underwent simultaneous bilateral surgical resection of multiple GGO lesions, 28 were women,6 were men, the average age of total patients was 57.9 ± 6.7 years. All patients underwent bilateral uni-portal video-assisted thoracoscopic surgery (Uni-portal VATS), the average intraoperative blood loss was 100.9 ± 67.7 ml, the average operation time was 140 ± 74.8 min, the average thoracic drainage time was 2.8 ± 3.1 days, and the average postoperative hospital stay was 4.2 ± 4.3 days. Postoperative complications including: 2 cases of infection, 3 cases of atrial fibrillation, and 5 cases of persistent air leakage for more than 3 days. All of them improved after treatment, and there were no serious complications and deaths in perioperative period. A total of 76 GGO lesions were resected, with a total malignancy rate of 81.6%, including 40 were pure GGO, of which 28 were malignant (70%), and the average diameter of them were 9.6 ± 3.8 mm; 36 were mixed GGO, of which 34 were malignant (94.4%), the average diameter of them were 15.6 ± 6.6 mm.Mean postoperative follow-up was 28.4 (range, 3–39) months. There was neither recurrence nor deaths at final follow-up.

The malignancy rate of multiple GGOs is high. Therefore, when the lung function is allowed,one-stage bilateral uni-portal VATS can be considered. According to experience of main surgeon and the frozen biopsy, either sub-lobar resection or lobectomy was acceptable. The risk of postoperative complications and the prognosis were optimal.

• Multiple ground-glass opacity (GGO);simultaneous;bilateral;video-assisted thoracoscopic surgery (VATS)

• diagnosis
• sMPLC
• synchronous multiple primary lung cancer
• treatment

• Multiple primary lung cancers (MPLCs)
• diagnosis
• ground-glass opacity (GGO)
• stereotactic body radiation therapy (SBRT)
• surgery

• Multiple primary lung cancer
• Surgery
• Thin layer distinguish CT
• Thoracoscope

The current study aimed to determine the oncological efficacy and surgical safety of multiple pulmonary resections (MPRs) after prior curative surgery for local regional recurrent or second primary lung cancers.

All cases of lung cancer included in our prospective database between January 2000 and July 2015 were retrospectively reviewed. The oncological efficacy endpoints for synchronous and metachronous MPR were five‐year overall survival (OS), disease‐free survival (DFS), and progression‐free survival (PFS) rates after the second surgery. The surgical safety endpoints were postoperative mortality and complications (Clavien‐Dindo classification) within 30 days.

In total, 67 MPR cases were identified. There were no significant differences in the five‐year OS and DFS between the synchronous MPR group (n = 50) and the propensity score‐matched solitary major pulmonary resection group (n = 250) (5‐year OS 84.5% vs. 69.0%, log rank P = 0.112; DFS 64.4% vs. 58.0%, log rank P = 0.278). The five‐year OS and PFS of the metachronous MPR group (n = 17) were significantly better than those in the non‐surgical control group (n = 19) (5‐year OS 94.1% vs. 50.7%, log rank P = 0.005; 5‐year PFS 53.9% vs. 10.5%, log rank P = 0.020). No postoperative mortality or severe complications occurred in the MPR group.

The oncological efficacy of MPR is superior to the non‐surgical approach for the management of local regional recurrent or second primary lung cancer, with comparable postoperative mortality and complications.

• Locoregional neoplasm recurrence
• lung neoplasm
• prognosis
• second primary cancer
• thoracic surgery

随着人们对肺癌早期筛查的重视，肺多发磨玻璃影（multiple ground glass opacities, GGOs）的检出率逐年增高，以GGOs为表现的多灶肺腺癌也逐渐成为临床研究热点。其更多见于女性、非吸烟者，且无论是自然病程还是手术后的患者均有极佳预后。独特的临床特征提示其很可能是相对独立的一种疾病形式。从分子遗传学路径对其的探究发现，同一个体内的多个病灶间极可能有截然不同的克隆性特征，因此遗传异质性（genetic heterogeneity）是以GGOs为表现多灶肺腺癌最显著的分子遗传学特征。此特征可辅助原发多灶肺腺癌与肺癌肺内转移的鉴别诊断，也提示了对病灶进行分子遗传学检测的治疗意义。部分呈现出遗传相似性的GGOs病灶为气腔播散转移（spread through air spaces, STAS）理论提供了新的证据。

• EGFR
• Genetic heterogeneity
• Multiple primary lung cancer
• Spread through air spaces (STAS)

随着高分辨率计算机断层扫描（high-resolution computed tomography, HRCT）应用的普及，多原发肺癌（multiple primary lung cancers, MPLC）的检出率逐年上升，其中腺癌是最常见的病理类型。目前国内外对MPLC的研究已相对多见，但罕有单独分析同时性多原发肺腺癌（synchronous multiple primary lung adenocarcinomas, SMPLA）的报道。本研究探讨SMPLA患者的临床病理特点及预后，旨在提高对SMPLA的认识。

对2012年12月-2016年7月期间我科38例临床资料保存完整的SMPLA患者进行了回顾性分析。

38例SMPLA患者中，男性12例，女性26例，中位年龄为58岁（39岁-73岁）。双原发肺腺癌29例，2个病灶以上9例。病灶位于同侧26例，双侧12例。同期手术34例（包括8例患者同期行双侧手术），分期手术4例。5例患者对每个病灶分别行基因检测，结果证实不同病灶的表皮生长因子受体（epidermal growth factor receptor, EGFR）基因突变类型不完全相同。1年和3年总生存率分别为96.6%和74.2%。肿瘤直径越大（P < 0.001）、T分期越高（P=0.003）、淋巴结转移（P=0.001）、TNM分期越高（P=0.022）以及术后放、化疗（P=0.009）提示总生存预后较差。

对于多发的非小细胞肺癌，不能轻易地诊断为转移癌，应考虑多原发可能。EGFR基因检测可作为鉴别多原发肺腺癌与复发转移癌的临床参考。