Multidisciplinary expert consensus on diagnosis and treatment of multiple lung cancers

Kezhong Chen; Anwen Liu; Changli Wang; Chengping Hu; Chun Chen; Fan Yang; Haiquan Chen; Hongbing Shen; Hongtao Zhang; Hongxu Liu; Jianping Xiong; Jie Wang; Li Zhang; Lin Xu; Lvhua Wang; Mingfang Zhao; Qiang Li; Qibin Song; Qinghua Zhou; Qun Wang; Shenglin Ma; Shidong Xu; Shuanghu Yuan; Shugeng Gao; Shun Lu; Weimin Li; Weimin Mao; Xiaoqing Liu; Xiaorong Dong; Xuening Yang; Yilong Wu; Ying Cheng; Yong Song; Yunchao Huang; Zhenfa Zhang; Zhiwei Chen; Zhiyong Ma; Christoph C Zielinski; Yu Shyr; Jun Wang; 7th Lung Cancer Expert Committee of China Anti-Cancer Association (CACA)

doi:10.1016/j.medj.2025.100643

Multidisciplinary expert consensus on diagnosis and treatment of multiple lung cancers

Med. 2025 Apr 11;6(4):100643. doi: 10.1016/j.medj.2025.100643.

Authors

Kezhong Chen¹, Anwen Liu², Changli Wang³, Chengping Hu⁴, Chun Chen⁵, Fan Yang¹, Haiquan Chen⁶, Hongbing Shen⁷, Hongtao Zhang⁸, Hongxu Liu⁹, Jianping Xiong¹⁰, Jie Wang¹¹, Li Zhang¹², Lin Xu¹³, Lvhua Wang¹⁴, Mingfang Zhao¹⁵, Qiang Li¹⁶, Qibin Song¹⁷, Qinghua Zhou¹⁸, Qun Wang¹⁹, Shenglin Ma²⁰, Shidong Xu²¹, Shuanghu Yuan²², Shugeng Gao²³, Shun Lu²⁴, Weimin Li²⁵, Weimin Mao²⁶, Xiaoqing Liu²⁷, Xiaorong Dong²⁸, Xuening Yang²⁹, Yilong Wu³⁰, Ying Cheng³¹, Yong Song³², Yunchao Huang³³, Zhenfa Zhang³, Zhiwei Chen³⁴, Zhiyong Ma³⁵, Christoph C Zielinski³⁶, Yu Shyr³⁷, Jun Wang³⁸; 7th Lung Cancer Expert Committee of China Anti-Cancer Association (CACA)

Affiliations

¹ Thoracic Oncology Institute, Peking University People's Hospital, Beijing 100044, China; Research Unit of Intelligence Diagnosis and Treatment in Early Non-small Cell Lung Cancer, Chinese Academy of Medical Sciences, 2021RU002, Peking University People's Hospital, Beijing 100044, China.
² Department of Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, China.
³ Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
⁴ Department of Respiratory Medicine, Xiangya Hospital of Central South University, Changsha, China.
⁵ Thoracic Surgery Department, Fujian Medical University Union Hospital, Fuzhou, China.
⁶ Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
⁷ Department of Epidemiology, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China.
⁸ Soochow University Laboratory of Cancer Molecular Genetics, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, China.
⁹ Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Cancer Hospital of China Medical University, Shenyang 110042, China.
¹⁰ Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
¹¹ Department of Medical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
¹² Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
¹³ Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China.
¹⁴ Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
¹⁵ Department of Medical Oncology, The First Hospital of China Medical University, Shenyang 110001, China.
¹⁶ Department of Respiratory Medicine, Shanghai Dongfang Hospital, Shanghai, China.
¹⁷ Department of Oncology, Cancer Center, Remin Hospital of Wuhan University, Wuhan, China.
¹⁸ Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.
¹⁹ Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
²⁰ Department of Oncology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou Cancer Hospital, Cancer Center, Zhejiang University School of Medicine, Hangzhou, China.
²¹ Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China.
²² Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong Cancer Hospital Affiliated with Shandong First Medical University, Jinan, China.
²³ Thoracic Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
²⁴ Department of Medical Oncology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
²⁵ Department of Respiratory and Critical Care Medicine, Med-X Center for Manufacturing, Center of Precision Medicine, Precision Medicine Key Laboratory of Sichuan Province, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, West China Medical School, Sichuan University, Chengdu 610041, China.
²⁶ Department of Cancer Medicine (Thoracic), Zhejiang Cancer Hospital, Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology (Esophagus, Lung), Hangzhou 310022, China.
²⁷ Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
²⁸ Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
²⁹ Department of Pulmonary Surgery, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
³⁰ Department of Pulmonary Oncology, Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guandong, China.
³¹ Department of Oncology, Jilin Cancer Hospital, Changchun, China.
³² Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China.
³³ Department of Thoracic Surgery I, Key Laboratory of Lung Cancer of Yunnan Province, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Cancer Center of Yunnan Province, Kunming, China.
³⁴ Department of Medical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³⁵ Department of Respiratory Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
³⁶ Medical Oncology, Central European Cancer Center, Wiener Privatklinik Hospital, Vienna, Austria.
³⁷ Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
³⁸ Thoracic Oncology Institute, Peking University People's Hospital, Beijing 100044, China; Research Unit of Intelligence Diagnosis and Treatment in Early Non-small Cell Lung Cancer, Chinese Academy of Medical Sciences, 2021RU002, Peking University People's Hospital, Beijing 100044, China. Electronic address: wangjun@pkuph.edu.cn.

PMID: 40220743
DOI: 10.1016/j.medj.2025.100643

Abstract

The rising incidence of multiple lung cancers (MLCs), encompassing multiple primary lung cancers (MPLCs) and intrapulmonary metastasis (IPM), poses two significant clinical challenges. First, distinguishing between MPLC and IPM remains difficult due to insufficiently accurate criteria and ambiguous integration of genetic testing. Second, standardized therapeutic protocols are still lacking. To address these issues, the Lung Cancer Expert Committee of China Anti-Cancer Association (CACA) assembled a multidisciplinary expert panel spanning thoracic surgery, pulmonary medicine, oncology, radiology, and pathology. Following a comprehensive literature review ending on October 23, 2024, the panel engaged in iterative discussions and conducted two rounds of expert voting, culminating in 25 evidence-based recommendations across five key domains: epidemiology, pre-treatment evaluation, definitive diagnostics, surgical treatment, and non-surgical treatment. This consensus provides clinicians with practical guidance to enhance diagnostic precision and therapeutic decision-making in MLC management while highlighting unmet needs to inform future guideline development.

Keywords: diagnosis; intrapulmonary metastasis; molecular genetics; multiple lung cancers; multiple primary lung cancers; non-small cell lung cancer; treatment.

Publication types

Review

MeSH terms

China
Consensus
Humans
Lung Neoplasms* / diagnosis
Lung Neoplasms* / epidemiology
Lung Neoplasms* / pathology
Lung Neoplasms* / therapy
Neoplasms, Multiple Primary* / diagnosis
Neoplasms, Multiple Primary* / epidemiology
Neoplasms, Multiple Primary* / therapy