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Cancer Med. 2019 Jun;8(6):3269-3277. doi: 10.1002/cam4.2172. Epub 2019 Apr 16.

Mortality of lung cancer as a second primary malignancy: A population-based cohort study.

Author information

1
Department of Thoracic Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
2
Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China.
3
Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
4
Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland.
5
Faculty of Medicine, Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
6
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
7
Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
8
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
9
Division of Medical Oncology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
10
Department of Radiation Oncology, Stanford University, Stanford, California, USA.

Abstract

Lung cancer as a second primary malignancy (lung-2) is increasingly common, but its prognosis is poorly understood. This study aims to examine the overall and cancer-specific survival of patients diagnosed with lung-2 compared to lung-1. Primary lung cancer patients diagnosed from 1988 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) program were included. Lung-2 was identified in patients with a previous diagnosis of nonlung primary malignancy in SEER. Hazard ratios (HRs) of overall and lung cancer-specific mortality were estimated among patients with lung-2 compared to lung-1, adjusting for age and calendar period at diagnosis, sex, race, socioeconomic status, tumor stage, histology, tumor grade, and treatment. A total of 679 541 and 85 758 patients were identified as lung-1 and lung-2, respectively. Compared to lung-1, patients with lung-2 were more likely to be diagnosed at localized stage, with smaller primary tumor, and treated with surgery. Lung-2 patients were at lower risk of lung cancer-specific mortality in the first 5 years (HR, 0.77; 95% CI, 0.76-0.78 at <1 year; HR, 0.87; 95% CI, 0.86-0.89 from 1 to <5 years) but at higher risk thereafter (HR, 1.32; 95% CI, 1.27-1.37 from 5 to 10 years), independent of tumor characteristics and cancer treatment. Similar pattern was found for overall mortality, although the survival benefit was restricted to the first year after diagnosis. Patients diagnosed with lung-2 face a favorable lung cancer-specific survival within the early period after diagnosis. A conservative approach to manage lung-2 solely based on malignancy history is not supported.

KEYWORDS:

cohort study; lung cancer; mortality; prognosis; second primary

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