Resection of Early-Stage Second Primary Non-small Cell Lung Cancer After Small Cell Lung Cancer: A Population-Based Study.

Rusi Zhang,Xiangyang Yu,Xuewen Zhang,Ling Cai,Fang Wang,Ningning Zhou,Longjun Yang,Dechang Zhao,Zirui Huang,Yingsheng Wen,Lanjun Zhang,Kexing Xi,Yongbin Lin,Gongming Wang

doi:10.3389/fonc.2019.01552

Abstract

Introduction: A certain number of small cell lung cancer (SCLC) patients become long-term survivors after treatment, and they are at high risk to develop a second primary malignancy, including non-small cell lung cancer. However, the optimal management of early-stage second primary non-small cell lung cancer (SPLC) after SCLC remains unknown. This study aims to evaluate the survival benefits of surgery in these patients.Methods: Patients with early-stage SPLC after SCLC were identified from the Surveillance, Epidemiology, and End Results database. Patients were balanced with propensity score matching (PSM). Overall survival (OS) and lung cancer-specific survival (CSS) were compared between non-surgery group and surgery group with the Kaplan–Meier method and Cox multivariate regressions.Results: A total of 228 patients with early-stage SPLC after SCLC were identified. Surgery was associated with significantly improved OS and CSS in the multivariate Cox regression analysis (OS, 5-year survival: 41.2 vs. 11.6%, HR: 0.42, 95% CI: 0.31–0.59, P < 0.01; CSS, 5-year survival: 46.8 vs. 24.3%, HR: 0.53, 95% CI: 0.37–0.75, P < 0.01). However, no statistically significant survival difference was found between sublobar resection and lobectomy (OS, 5-year survival: 41.0 vs. 45.3%, P = 0.73; CSS, 5-year survival: 43.5 vs. 54.1%, P = 0.49). After 1:1 PSM, 162 patients were selected for further analysis, and surgery continued to demonstrate superior survival (OS, 5-year survival: 44.2 vs. 7.2%, HR: 0.48, 95% CI: 0.33–0.70, P < 0.01; CSS, 5-year survival: 48.0 vs. 20.6%, HR: 0.44, 95% CI: 0.42–0.97, P = 0.03).Conclusion: The resection of early-stage SPLC after SCLC led to significantly improved OS and CSS and therefore should be considered whenever possible. Nevertheless, further randomized controlled trials are warranted to investigate the safety and effect of surgery in these patients.

Highlights

A certain number of small cell lung cancer (SCLC) patients become long-term survivors after treatment, and they are at high risk to develop a second primary malignancy, including non-small cell lung cancer
It is well-established that different histology is one of the most robust criteria for the diagnosis of second primary lung cancer, which are endorsed by both International Association for the Study of Lung Cancer (IASLC) TNM staging proposal and American College of Chest Physicians (ACCP) guideline [6, 7]
We searched the Surveillance, Epidemiology, and End Results (SEER) database to analyze the characteristics of early-stage SPLC after Small cell lung cancer (SCLC), and we aimed to evaluate the survival benefits of surgery for these patients

Summary

Introduction

A certain number of small cell lung cancer (SCLC) patients become long-term survivors after treatment, and they are at high risk to develop a second primary malignancy, including non-small cell lung cancer. Previous studies have demonstrated that these patients are at high risk for developing a second primary malignancy, including nonsmall cell lung cancer (NSCLC), possibly related to the secondary effect of chemoradiation [4, 5]. It is well-established that different histology is one of the most robust criteria for the diagnosis of second primary lung cancer, which are endorsed by both International Association for the Study of Lung Cancer (IASLC) TNM staging proposal and American College of Chest Physicians (ACCP) guideline [6, 7]. It is reasonable to consider NSCLC diagnosed after SCLC as second primary lung cancer because these two cancers are different in histology

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