Clinical outcome in lung cancer with a second malignancy

Abstract

The aim of the study was to determine the clinical outcome of lung cancer patients with a secondary malignancy according to the time sequence between the lung cancer and the secondary malignancy.Retrospective review of all lung cancer patients with any secondary cancer treated from June 2004 to July 2012. The survival of patients with a secondary malignancy was compared to those patients without a secondary malignancy. According to the time sequence between the lung cancer and the secondary malignancy, patients were divided into 4 groups. Group I: lung cancer without any other malignancy, Group II: lung cancer with a secondary malignancy at follow-up, Group III: lung cancer with a pre-existing malignancy, Group IV: synchronous malignancies (diagnosis interval between lung cancer and a secondary malignancy of less than 3 months).Patients with any secondary cancer in their history or at follow up included 157 patients (9.5%). Collectively; the median survival was significantly better for patients with a secondary malignancy, 19.09 months, compared to those without a secondary malignancy, 9.53 months, P < 0.001, HR 0.66 (95% CI 0.55 – 0.79). However, the survival differed significantly according to the time sequence between the lung cancer and the secondary malignancy. The median survival was 47.9 months for group II patients, 12.19 months for group III, 17.51 months for group IV, and 9.53 months for group I; P = 0.001. In Cox proportional hazard analysis, the risk of dying decreased by 68% in group II patients compared to group I patients, HR 0.32 (95% CI 0.21–0.5), P < 0.001. Although the risk of dying for group III and IV decreased by 19% and 16% respectively compared to group I patients, it did not reach statistical significance.Nowadays, secondary malignancy in lung cancer patients is a frequent finding. Better survival was observed for patient with secondary malignancy following lung cancer.

Previous Extrapulmonary Malignancies Impact Outcomes in Patients With Surgically Resected Lung Cancer

“…The incidence of previous extrapulmonary malignancies in our study was similar to those reported previously (1-22%) (7,8,(18)(19)(20)(21)(22)(23)(24)(25)(26). Corresponding to an increase in the incidence of multiple primary cancers, a surge of 5.7% in lung cancer as a second primary malignancy was also noted between 1988-1992 and 2011-2014 in the United States National Cancer Institute's Surveillance, Epidemiology, and End Results Program (19).…”

Clinic image surveillance reduces mortality in patients with primary hepato-gastrointestinal cancer who develop second primary lung cancer

“…[ 4 ] Lu et al has reported the median survival was 12 months for second primary lung cancer. [ 14 ] In this study, the median survival was 27 months in patients whose lung cancer was diagnosed in primary hepato-GI clinic, better than the previously reported second primary lung cancer. [ 14 ] We also found that those with diagnosis of second primary lung cancer not in primary hepato-GI clinic had worse clinical outcome (median survival: 10 months) and included more stage III and IV lung cancer.…”

“…[ 14 ] In this study, the median survival was 27 months in patients whose lung cancer was diagnosed in primary hepato-GI clinic, better than the previously reported second primary lung cancer. [ 14 ] We also found that those with diagnosis of second primary lung cancer not in primary hepato-GI clinic had worse clinical outcome (median survival: 10 months) and included more stage III and IV lung cancer. Therefore, as patients survive first cancer, surveillance in clinic may reduce the mortality from second primary malignancies owing to early detection.…”

“…In our cohort, 28.4% of the first primary tumors were hepato-GI cancer, followed by head and neck cancer and urology cancer, and the distribution of first primary malignancies was similar to previously report in Taiwan. [ 14 ]…”

“…Gastrointestinal (GI) cancer is the one of the most common cancers to develop a second primary lung cancer. [ 4 , 6 , 14 ] The number of GI cancer survivors has increased due to improvements in early diagnosis and treatment, therefore, second primary malignancy has become a threat to patient survival. Post-treatment surveillance, including radiological image screen, endoscopic evaluation or tumor markers, has been suggested to detect recurrence.…”