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J Thorac Cardiovasc Surg 1999;117:405-406
© 1999 Mosby, Inc.

LETTERS TO THE EDITOR

Multiple primary lung carcinomas

The report by Okada and colleagues ¹ highlights the treatment options and survival statistics that are appropriate for patients with multiple primary lung carcinomas (MPLCs), but we think some further points need to be discussed.

In a recent article by Antakli and colleagues, ² a set of criteria modified from Martini and Melamed ³ has been applied to differentiate MPLCs and recurrence of satellite nodules. In addition to those mentioned by Okada and associates, associated premalignant lesions and different DNA ploidy have been presented as the 2 other criteria in the case of identical histologic type. ² When Martini and Melamed's criteria were not conclusive, they advocated DNA ploidy to provide a definite answer to this dilemma. However, Okada and colleagues have not suggested using the ploidy issue for patients with MPLCs.

We performed left pneumonectomy for a 60-year-old man who was operated on for squamous cell carcinoma of the lung (T2 N1 M0, grade III). One year after the operation, a nodule with a 2.5-cm diameter located in the right upper lobe was detected by both chest roentgenography and chest computed tomography. Segmentectomy was performed, and the histologic type of this tumor was the same as that of the first one (T2 N0 M0, grade III). We considered this tumor to be a second primary lung cancer, because the tumor was anatomically separate and did not have any systemic metastases or mediastinal spread. On the other hand, although the number of criteria that had to be met in the case of identical histologic type was sufficient, we used the ploidy issue in our patient. Even though the histologic features were the same in all of the lesions, the DNA ploidy signatures differed.

Although lung-saving procedures for a primary lesion are advocated in the article, ¹ the risk of having MPLCs after pneumonectomy is significantly lower than after lobectomies or miniresections. ²

Another point is the striking prevalence of smoking among the patients with MPLCs and the preventive effect of cessation that has been demonstrated by many authors. ^2,4 Do Okada and associates have any information about the prevalence of smoking among their patients?

From the historical point of view, we would like to know whether the first case of MPLCs was described by Beyreuther in 1924, as mentioned by Okada and colleagues, ¹ or whether the first case was described in 1928, as pointed out by Chaudhuri. ⁵

Bedrettin Y1ld1zeli, MD
Mustafa Yüksel, MD
Sina Ercan, MD
Hasan F. Bat1rel, MD
Marmara University Faculty of Medicine
Department of Thoracic Surgery
Istanbul, Turkey

12/8/94818

References

1. Okada M, Tsubota N, Yoshimura M, Miyamoto Y. Operative approach for multiple primary lung carcinomas. J Thorac Cardiovasc Surg 1998;115:836-40. [Abstract/Free Full Text]
   
2. Antakli T, Schaefer RF, Rutherford JE, Read RC. Second primary lung cancers. Ann Thorac Surg 1995;59:863-7. [Abstract/Free Full Text]
   
3. Martini N, Melamed MR. Multiple primary lung cancers. J Thorac Cardiovasc Surg 1975;70:606-12. [Abstract]
   
4. Richardson GE, Tucker MA, Venzon DJ, et al. Smoking cessation after successful treatment of small-cell lung cancer is associated with fewer smoking-related second primary cancers. Ann Intern Med 1993;119:383-90. [Abstract/Free Full Text]
   
5. Chaudhuri MR. Independent bilateral primary bronchial carcinomas. Thorax 1971;26:476-80. [Abstract/Free Full Text]
   

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