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Lee HY, Hsieh MS, Liao HC, Chen PH, Chiang XH, Tsou KC, Tsai TM, Chuang JH, Lin MW, Hsu HH, Chen JS. Previous Extrapulmonary Malignancies Impact Outcomes in Patients With Surgically Resected Lung Cancer. Front Surg 2021; 8:747249. [PMID: 34676241 PMCID: PMC8523860 DOI: 10.3389/fsurg.2021.747249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background: As the overall survival of patients with cancer continues to improve, the incidence of second primary malignancies seems to be increasing. Previous studies have shown controversial results regarding the survival of patients with primary lung cancer with previous extrapulmonary malignancies. This study aimed to determine the clinical picture and outcomes of this particular subgroup of patients. Materials and Methods: We included 2,408 patients who underwent pulmonary resection for primary lung cancer at our institute between January 1, 2011 and December 30, 2017 in this retrospective study. Medical records were extracted and clinicopathological parameters and postoperative prognoses were compared between patients with lung cancer with and without previous extrapulmonary malignancies. Results: There were 200 (8.3%) patients with previous extrapulmonary malignancies. Breast cancer (30.5%), gastrointestinal cancer (17%), and thyroid cancer (9%) were the most common previous extrapulmonary malignancies. Age, sex, a family history of lung cancer, and preoperative carcinoembryonic antigen levels were significantly different between the two groups. Patients with previous breast or thyroid cancer had significantly better overall survival than those without previous malignancies. Conversely, patients with other previous extrapulmonary malignancies had significantly poorer overall survival (p < 0.001). The interval between the two cancer diagnoses did not significantly correlate with clinical outcome. Conclusion: Although overall survival was lower in patients with previous extrapulmonary malignancies, previous breast or thyroid cancer did not increase mortality. Our findings may help surgeons to predict prognosis in this subgroup of patients with primary lung cancer.
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Affiliation(s)
- Hsin-Ying Lee
- Department of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Hsing Chen
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | - Xu-Heng Chiang
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Douliu, Taiwan
| | | | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jen-Hao Chuang
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Hong J, Wei R, Nie C, Leonteva A, Han X, Du X, Wang J, Zhu L, Tian W, Zhou H. The risk and prognosis of secondary primary malignancy in lung cancer: a population-based study. Future Oncol 2021; 17:4497-4509. [PMID: 34402680 DOI: 10.2217/fon-2021-0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To assess and predict risk and prognosis of lung cancer (LC) patients with second primary malignancy (SPM). Methods: LC patients diagnosed from 1992 to 2016 were obtained through the Surveillance, Epidemiology, and End Results database. Standardized incidence ratios were calculated to evaluate SPM risk. Cox regression and competing risk models were applied to assess the factors associated with overall survival, SPM development and LC-specific survival. Nomograms were built to predict SPM probability and overall survival. Results & conclusion: LC patients remain at higher risk of SPM even though the incidence declines. Patients with SPM have a better prognosis than patients without SPM. The consistency indexes for nomograms of SPM probability and overall survival are 0.605 (95% CI: 0.598-0.611) and 0.644 (95% CI: 0.638-0.650), respectively.
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Affiliation(s)
- Jia Hong
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Rongrong Wei
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Chuang Nie
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Anastasiia Leonteva
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Xu Han
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Xinyu Du
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Jing Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Lin Zhu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Wenjing Tian
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Haibo Zhou
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
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Huang HY, Lu MW, Chen MC, Chang HM, Kuo CH, Lin SM, Wang CH, Chung FT. Clinic image surveillance reduces mortality in patients with primary hepato-gastrointestinal cancer who develop second primary lung cancer: A STROBE-compliant retrospective study. Medicine (Baltimore) 2020; 99:e23440. [PMID: 33327274 PMCID: PMC7738109 DOI: 10.1097/md.0000000000023440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Second primary cancer is prevalent in patients with gastrointestinal (GI) cancer, for which lung cancer is the most common and associated with high lethality. Image screening for lung cancer was proved to be effective in early diagnosis and lower mortality. However, trials of screen for lung cancer generally excluded patients with a previous diagnosis of malignancy. The study aimed to investigate the outcome of second primary lung cancer and the factor that improve survival in patients with hepato-GI cancer.A total of 276 patients with secondary lung cancer were found among 3723 newly-diagnosed lung cancer patients diagnosed in Chang Gung Memorial Hospital, between 2010 and 2014. Patients' clinical characteristics, stages and survival were recorded and analyzed. The patients were separated into 2 groups: Group I was defined as lung cancer detected in original primary cancer clinic and group II patients defined as lung cancer detected in other medical places.Sixty-nine cases with primary GI-hepatic and secondary lung cancer were diagnosed (42 (60.8%) in Group I and 27 (39.1%) in Group II). Although both groups had comparable primary cancer stages and treatment, more patients in Group I than Group II were diagnosed as early stage lung cancer (stage I-II: 40.5% vs 11.1%; P = .023). Group II had larger lung tumor sizes than Group I (4.7 vs 3.5 cm; P = .025). Group I showed better 5-year overall survival than Group II (P = .014, median survival: 27 vs 10 months). Among Group II, only 37% had received image follow up in clinic compared with 67% of Group I cases (P = .025). Patients with chest image follow up in clinics also had better 5-year overall survival (P = .043).GI-hepatic cancer was the most common primary malignancy in the lung cancer cohort. Patients had better survival outcome when secondary lung cancer was diagnosed in original primary cancer clinic. Chest image screening strategy may contribute better survival in secondary lung cancer due to detection at an earlier stage.
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Affiliation(s)
- Hung-Yu Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Min-Wei Lu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Medical Education Department, Far Eastern Memorial Hospital, New Taipei City
| | - Mei-Chi Chen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan
| | - Hsiu-Mei Chang
- Department of Respiratory Care, New Taipei City Municipal TuCheng Hospital, Managed by Chang Gung Medical Foundation, New Taipei City
| | - Chih-Hsi Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Fu-Tsai Chung
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Respiratory Care, New Taipei City Municipal TuCheng Hospital, Managed by Chang Gung Medical Foundation, New Taipei City
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Managed by Chang Gung Medical Foundation, New Taipei City, Taiwan
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Singnurkar A, Swaminath A, Metser U, Langer DL, Darling GE, Pond GR. The impact of synchronous malignancies on survival in patients with early stage curable non-small-cell lung cancer. Cancer Treat Res Commun 2020; 25:100246. [PMID: 33248389 DOI: 10.1016/j.ctarc.2020.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To determine if synchronous extrapulmonary malignancies in early stage lung cancer impact survival and cost of care in the current era of improved therapies and diagnostics. METHODS Patients with stage I and II lung cancer were identified from the Ontario Cancer Registry and prognostic factors were obtained from provincial health administrative databases. Synchronous extrapulmonary malignancies were defined as those detected within 6 months from diagnosis of the lung primary. Survival was calculated using the Kaplan-Meier method and examined based on a 6-month landmark time point. The log-rank test and Cox proportional hazards regression was used to examine the effect of synchronous primaries on survival, univariately and after adjusting for prognostic factors. Cost of care was calculated by summing fees for all provincially funded services over 3 years. RESULTS In a cohort of 6890 patients, those with synchronous malignancy had a HR of 1.32 (p = 0.026) for death in stage I patients, adjusted for other factors, while no association was found for stage II patients (HR=1.00, p = 0.99). 18F-FDG-PET/CT up to 6 months prior to lung cancer diagnosis had a HR of 0.84 (p = 0.003) for death adjusted for other factors. 3-year costs of care for these patients were $79,540 versus $54,520 in those without a synchronous malignancy (p<0.001). CONCLUSION Extrapulmonary malignancies in stage I lung cancer patients may negatively impact survival with no such association for stage II patients. 18F-FDG-PET/CT performed before lung cancer diagnosis is associated with better survival. Cost of care is higher in patients with synchronous malignancies.
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Affiliation(s)
- Amit Singnurkar
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada.
| | - Anand Swaminath
- Juravinski Cancer Centre, 699 Concession St, Hamilton, ON, L8V 5C2, Canada; McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Ur Metser
- University Health Network, 200 Elizabeth St, Toronto, ON, M5G, 2C4, Canada; University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada; Ontario Health (Cancer Care Ontario), 620 University Ave, Toronto, ON, M5G 2L7, Canada
| | - Deanna L Langer
- Ontario Health (Cancer Care Ontario), 620 University Ave, Toronto, ON, M5G 2L7, Canada
| | - Gail E Darling
- University Health Network, 200 Elizabeth St, Toronto, ON, M5G, 2C4, Canada; University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada; Ontario Health (Cancer Care Ontario), 620 University Ave, Toronto, ON, M5G 2L7, Canada
| | - Gregory R Pond
- Juravinski Cancer Centre, 699 Concession St, Hamilton, ON, L8V 5C2, Canada; McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
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Ko KH, Huang HK, Chen YI, Chang H, Tsai WC, Huang TW. Surgical outcomes of second primary lung cancer after the extrapulmonary malignancy. J Cancer Res Clin Oncol 2020; 146:3323-3332. [PMID: 32632580 DOI: 10.1007/s00432-020-03310-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To study the surgical outcomes of patients with a second primary lung cancer after the extrapulmonary malignancy. MATERIALS AND METHODS Patients who underwent surgical resection for lung cancers between January 2005 and December 2014 were reviewed. Clinical data, imaging characteristics of tumors, surgical approaches, and outcomes were analyzed with a mean follow-up of 97 months. RESULTS Of 1075 patients, 166 (15.4%) had a second primary lung cancer after extrapulmonary malignancy. There were no differences in overall 5-year survival rates (81.8% for the group of lung cancer vs. 72.9% for the second primary lung cancer group, p = 0.069) and 5-year disease-free survival (70.1% for the lung cancer group vs. 70.3% for the second primary lung cancer group, p = 0.863) between the two groups. Gender, performance status, tumor size, and maximum standard uptake value (SUVmax) were significantly different between the two groups. After propensity-score matching analysis, patients in the group with lung cancers had better 5-year overall survival (88.1% vs. 72.1% for the group with second primary lung cancers, p = 0.016) and 5-year disease-free survival (80.6% vs. 70.3% for the group with second primary lung cancers; p = 0.054). In the second primary lung cancer group, the patients with preceding breast or thyroid cancers had better prognoses than did those with other extrapulmonary malignancy. CONCLUSIONS Second primary lung cancers following extrapulmonary malignancies were not uncommon. Surgical resection is considered for early stage secondary primary lung cancer after meticulous work up and result in fair outcome.
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Affiliation(s)
- Kai-Hsiung Ko
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsu-Kai Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-I Chen
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hung Chang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chuan Tsai
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Second malignancy in non-small cell lung cancer (NSCLC): prevalence and overall survival (OS) in routine clinical practice. J Cancer Res Clin Oncol 2018; 144:2059-2066. [DOI: 10.1007/s00432-018-2714-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/19/2018] [Indexed: 12/19/2022]
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Causes of death and competing risk analysis of the associated factors for non-small cell lung cancer using the Surveillance, Epidemiology, and End Results database. J Cancer Res Clin Oncol 2017; 144:145-155. [PMID: 28980067 DOI: 10.1007/s00432-017-2522-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/17/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate the probability of death (POD) from any causes by time after diagnosis of non-small cell lung cancer (NSCLC) and the factors associated with survival for NSCLC patients. METHODS A total of 202,914 patients with NSCLC from 2004 to 2013 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The overall survival (OS) and lung cancer-specific survival (LCSS) were calculated and POD from any causes at different time periods after diagnosis was explored. The predictive factors for OS, LCSS and survival from non-lung cancer deaths were investigated using multivariate analysis with Cox proportional hazards regression and competing risk regression analysis. RESULTS The 5- and 10-year OS were 20.4% and 11.5%, accordingly that for LCSS were 25.5% and 18.4%, respectively. Lung cancer contributed 88.3% (n = 128,402) of the deaths. The POD from lung cancer decreased with time after diagnosis. In multivariate analysis, advanced age and advanced stage of NSCLC were associated with decreased OS and LCSS. Comparing to no surgery, any kind of resection conferred lower risk of death from lung cancer and higher risk of dying from non-lung cancer conditions except lobectomy or bilobectomy, which was associated with lower risk of death from both lung cancer and non-lung cancer conditions. CONCLUSIONS Most of the patients with NSCLC died from lung cancer. Rational surveillance and treatment policies should be made for them. Early stage and lobectomy or bilobectomy were associated with improved OS and LCSS. It is reasonable to focus on early detection and optimal surgical treatment for NSCLC.
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