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<p>The global clinical trial landscape for multiple primary lung cancer (MPLC) exhibits a striking geographic anomaly. Through a systematic analysis of 8212 lung cancer registrations (2015–2024), we identified a cohort of 17 trials explicitly targeting MPLC. Analysis revealed an absolute geographic monopole: 100% of these trials were investigator-initiated in China, with a complete absence of active protocols in Western registries. We argue that this segregation is not accidental but driven by the “Asian phenotype”,which is characterized by indolent, multifocal ground-glass nodules (GGNs), demands lung-sparing local strategies distinct from the systemic paradigms favored in the West. We urge the international community to transition from universal guidelines to phenotype-stratified management frameworks.</p>

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The “Asian Paradox” in multiple primary lung cancer: a geographic monopole driven by phenotypic divergence

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月6日

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  • Jianwei Shi,
  • Yushun Gao

摘要

The global clinical trial landscape for multiple primary lung cancer (MPLC) exhibits a striking geographic anomaly. Through a systematic analysis of 8212 lung cancer registrations (2015–2024), we identified a cohort of 17 trials explicitly targeting MPLC. Analysis revealed an absolute geographic monopole: 100% of these trials were investigator-initiated in China, with a complete absence of active protocols in Western registries. We argue that this segregation is not accidental but driven by the “Asian phenotype”,which is characterized by indolent, multifocal ground-glass nodules (GGNs), demands lung-sparing local strategies distinct from the systemic paradigms favored in the West. We urge the international community to transition from universal guidelines to phenotype-stratified management frameworks.