CAJ | 학술논문

多原发性肺癌的发病率和检出率逐年升高。目前临床上诊断多原发性肺癌（multiple primary lung can-cer, MPLC）主要参照Martini-Melamed标准和美国胸科医师协会（American College of Chest Physicians, ACCP）标准，综合考虑临床表现、影像学特征、组织学类型和分子遗传学特征。组织学类型不同的MPLC诊断相对容易，而组织学类型相同的MPLC诊断仍相当困难。DNA倍体分析、基因突变检测、微卫星多态性分析等分子生物学技术为MPLC的正确诊断提供了新手段，可评估各病灶的克隆性关系，帮助鉴别MPLC与转移。MPLC的首选治疗方案为根治性手术，术式应考虑患者肺功能储备等因素，选择肺叶切除、肺段切除或楔形切除；对于不能根治性切除的病灶，可综合化疗、放疗、立体定向放疗（stereotactic ablative radiotherapy, SABR）、射频消融（radiofrequency ablation, RFA）、分子靶向治疗等。
다원발성폐암적발병솔화검출솔축년승고。목전림상상진단다원발성폐암（multiple primary lung can-cer, MPLC）주요삼조Martini-Melamed표준화미국흉과의사협회（American College of Chest Physicians, ACCP）표준，종합고필림상표현、영상학특정、조직학류형화분자유전학특정。조직학류형불동적MPLC진단상대용역，이조직학류형상동적MPLC진단잉상당곤난。DNA배체분석、기인돌변검측、미위성다태성분석등분자생물학기술위MPLC적정학진단제공료신수단，가평고각병조적극륭성관계，방조감별MPLC여전이。MPLC적수선치료방안위근치성수술，술식응고필환자폐공능저비등인소，선택폐협절제、폐단절제혹설형절제；대우불능근치성절제적병조，가종합화료、방료、입체정향방료（stereotactic ablative radiotherapy, SABR）、사빈소융（radiofrequency ablation, RFA）、분자파향치료등。
Recently, the incidence and detection rates of multiple primary lung cancer (MPLC) are increasing. hTe diagnosis of MPLC depends mainly on the Martini-Melamed criterion and ACCP criterion at present, taking all features (histological, genetic, radiologic and clinical) into account. It may be easy to diagnose cases of MPLC that exhibit different his-tological types, but it is diffcult to diagnose cases that exhibit similar histological type. DNA polity, gene mutations, microsatel-lite alteration and so on provide new methods for the accurate diagnosis of MPLC. hTey can evaluate the clonal relationship and help differential diagnosis between MPLC and metastasis. hTe ifrst therapeutic choice for MPLC is curative operation. hTe surgical approach includes lobectomy, wedge resection and segmentectomy. For those which cannot be resected, we can synthesize chemotherapy, radiotherapy, stereotactic ablative radiotherapy (SABR), radiofrequency ablation (RFA), molecular targeted therapy, etc.