ارزش گذاری منظم ماده ای از توالی 50 ژن پانل برای تشخیص چندین سرطان ریوی اولیه از متاستاز های ریوی - یک مطالعه سیستماتیک

Differentiation between multiple primary lung cancers or pulmonary metastases has important implications for staging, prognosis, and treatment strategies. Clinical and immuno-histopathological criteria have been standardized; however, a substantial number of cases remain difficult to classify. Using next-generation sequencing it is now possible to improve classification of multiple lung cancer lesions. This study systematically investigated the value of routine morphological and immunohistochemical characteristics, p53 protein expression, TP53 mutation analysis, and 50-gene panel sequencing on 111 lesions from 50 patients with multiple lung lesions. Based on immuno-histopathological criteria, 32 paired lesions were classified as multiple primary lung cancer (MPLC) and 21 as pulmonary metastasis. TP53 mutation analysis indicated MPLC for 23 and pulmonary metastasis for six pairs, but of the majority of cases (n=28, 49%) no mutation was observed and no conclusion could be drawn. In contrast, only two pairs were not conclusive using gene panel sequencing. In a significant number of matching tumor samples (n=19, 39%), sequencing results were in contradiction to the initial immuno-histopathology diagnosis. No separation in overall survival for classifications based on immuno-histopathology was observed, while a clear but non-significant trend was observed concerning the survival for MPLC patients (HR 3.98) using 50-gene sequencing. For about one-third of the patients, panel sequencing provided additional information to improve the differentiation between multiple primary lung cancers or pulmonary metastases.