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Meta-Analysis
. 2021 Jan;10(2):507-520.
doi: 10.1002/cam4.3614. Epub 2020 Dec 10.

Characteristics and prognosis of synchronous multiple primary lung cancer after surgical treatment: A systematic review and meta-analysis of current evidence

Hongtao Tie  1 , Jun Luo  1 , Rui Shi  2   3 , Zhenhan Li  4 , Dan Chen  1 , Qingchen Wu  1
Affiliations
Meta-Analysis

Characteristics and prognosis of synchronous multiple primary lung cancer after surgical treatment: A systematic review and meta-analysis of current evidence

Hongtao Tie et al. Cancer Med. 2021 Jan.

Abstract

Background: This study aims to quantitatively summary the characteristics of synchronous multiple primary lung cancer (sMPLC), postoperative mortality, long-term prognosis, and prognostic effects of potential clinical parameters in patients with sMPLC after surgery.

Methods: PubMed and Embase databases were systematically searched to identify studies that explored the prognosis of patients with sMPLC after surgery.

Results: Fifty-two studies with 3486 participants were included, and clinical characteristics were quantitatively summarized. The pooled proportion of sMPLC in lung cancer was 2.0% (95%CI, 1.6%-2.5%) with an increasing trend over time, and postoperative mortality was 1.4% (95%CI, 0.5%-2.7%) with a decreasing trend over time. The 5-year survival rate was 44.9% (95%CI, 37.4%-52.6%) and all long-term survival rates showed increasing trends over time. Poor long-term prognosis was observed in both limited resection (HR = 1.357, 95%CI, 1.047-1.759, p = 0.0210) and pneumonectomy (HR = 2.643, 95%CI, 1.539-4.541, p = 0.0004) by comparison of anatomical resection. Other clinical parameters of age, gender, smoking status, FEV1, and lymph node metastasis significantly impacted the long-term prognosis (all p < 0.05).

Conclusions: The proportion of sMPLC in lung cancer and 5-year survival rate are increasing, while postoperative mortality is decreasing trend over time. Lobectomy should be preferred, while pneumonectomy should be avoided for sMPLC. Age, gender, FEV1, smoking, tumor size, surgical methods, and lymph node status are prognostic factors for sMPLC. Considering the heterogeneity and publication bias, these findings should be treated with caution.

Keywords: prognosis; surgical treatment; synchronous multiple primary lung cancer; systematic review and meta-analysis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Flow chart of study selection
FIGURE 2
FIGURE 2
Distributions between publication year and (A) proportion of sMPLC in lung cancer, (B) postoperative mortality rate, (C) 1‐year survival rate, (D) 2‐year survival rate, (E) 3‐year survival rate, (F) 5‐year survival rate. Every bubble represents one study, and publication year is for X‐axis, Y‐axis for the corresponding rate, and the area of the bubble for corresponding sample size. Correlation relationships were analyzed by Spearman's rank correlation. r means correlation coefficient and p means statistical test
FIGURE 3
FIGURE 3
Subgroup analysis and additional analysis. (A) Subgroup analysis according to publication year of proportion of sMPLC in lung cancer, postoperative mortality rate, and 5‐year survival rate. (B) Additional analysis of 5‐year survival rate according to various clinical parameters. All meta‐analyses are performed with random‐effects model, and differences between two subgroups are analyzed by metareg with R package
FIGURE 4
FIGURE 4
Additional analysis of overall survival according to various clinical parameters. All meta‐analyses were performed with random‐effects model. HR more than 1 means the results favor reference group
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