Dual Primary Cancer Patients With Lung Cancer as a Second Primary Malignancy: A Population-Based Study.

Zixin Guo,Donghu Yu,Congkuan Song,Yujin Wang,Weidong Hu,Sheng Li,Jingyu Huang,Qingwen Wang

doi:10.3389/fonc.2020.515606

Abstract

BackgroundResearch on patients with lung cancer as a second primary malignancy (LCSPM) remains limited. This study aims to determine the clinical characteristics, prognosis, and temporal relationship of other cancers to lung cancer in these patients.MethodsThis study retrospectively analyzed 3465 patients with dual primary cancers from the 5253 patients with LCSPM retrieved from the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2015.Results2285 eligible patients were further analyzed in this study cohort with 59.3% of 1-year OS, 34.7% of 3-year OS, and 25.2% of 5-year OS. The most common first primary cancer (FPC) in dual primary cancer patients with LCSPM was prostate cancer, followed by female breast cancer and urinary bladder cancer. In the entire study population, the median interval between the two primary malignancies was 21 months (range: 3.5–52 months). Age, sex, FPC location, surgery, stage, and histology of lung cancer were regarded as independent prognostic factors for these patients. The prognosis of patients with urinary bladder cancer as FPC was the worst in the univariate (p = 0.024) and multivariate (p < 0.001) Cox analyses. Lung cancer-directed surgery could significantly improve long-term survival (HR = 0.22, p < 0.001). Additionally, the C-index of the established nomogram with acceptable calibration curves was 0.760 (95% CI: 0.744–0.776) in the training cohort and was 0.759 (95% CI: 0.737–0.781) in the validation cohort, showing an ideal model discrimination ability. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility.ConclusionsCancer patients still have the risk of developing a new primary lung cancer. Close, lifelong follow-up is recommended for all these patients. Early detection for surgical treatment will significantly improve the prognosis of dual primary cancer patients with LCSPM. The nomogram developed to predict 1-, 3-, and 5-year OS rates has relatively good performance.

Highlights

Lung cancer poses a serious threat to public health due to its high morbidity and mortality
Sex, first primary cancer (FPC) location, surgery, stage, and histology of lung cancer were regarded as independent prognostic factors for these patients
Cancer patients still have the risk of developing a new primary lung cancer

Summary

Introduction

Lung cancer poses a serious threat to public health due to its high morbidity and mortality. Little attention has been paid to multiple primary cancers (MPC) involving lung cancer. When patients have multiple primary malignancies at the same time, it is complicated for clinicians to judge the prognosis of these patients. The TNM staging system is the most widely used method for evaluating prognosis, it still has some limitations, especially for patients with multiple primary malignancies (they tend to have special biological characteristics different from single primary malignancy). This study is to conduct a retrospective analysis based on the clinical information of LCSPM patients to understand the common site distribution of the first primary cancer (FPC) and time interval between two primary malignancies and to determine the prognostic factors and to develop a nomogram that can predict the survival in order to provide certain evidence for guiding clinical practice. This study aims to determine the clinical characteristics, prognosis, and temporal relationship of other cancers to lung cancer in these patients

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