Stage I lung cancer survivorship: Incidence of secondary malignancies and need for individualized care plan.

Abstract

9074 Background: There is paucity of published data addressing long term survivorship of patients treated with curative intent for stage I Lung cancer. Using a population based approach we planned to study the trends in incidence and survival of Stage I lung cancer as well as the incidence of secondary malignancies. Methods: We conducted analysis of the data from the Surveillance Epidemiology and End results data base of patients diagnosed with Stage I lung cancer. Survival analysis was done by calculating the observed 5 year survival from 1988 to 2003, so that it gives us at least 5 years of follow up. Using multiple outcome analysis we calculated the Observed/ Expected ratio of all secondary malignancies in the survivors diagnosed from 1988-2003. Results: The age adjusted incidence rate of stage I lung cancer shows only slight increase from 1988 (18.5, CI: 17.6- 19.4) to 2003 (21.4, CI: 20.6- 22.3) but shows a steady increase from 2003 to 2007 (26, CI: 24.8- 27.3). In the SEER database there were 44,960 patients with newly diagnosed stage 1 Lung cancer during 1988-2003. That gave us 181,158.59 patient years of follow up. The observed 5 year survival has not changed since 1988 (45.5%, CI: 42.80%- 48%) to 2003 (45.4%, CI: 42.9%- 47.9%). Risk of second lung cancer is highest in the 1st year with Observed /Expected ratio (O/E) 6.78 (CI: 6.29-7.31; N= 695) and continues to be high at 10 years O/E 4.12 (CI: 4.44- 4.80; N=276). Laryngeal cancer has the highest risk is in the first year (O/E 9.78 CI: 7.51- 12.51; N= 63) and continues to be high at 10 years. For GI there is increased risk of colon (O/E 1.33 CI: 1.22-1.44; N=568), esophagus (O/E 2.29; CI: 1.85-2.89; N=91) and stomach (O/E1.43 CI: 1.15-1.75; N=94). In the genitourinary system there is increased risk of bladder cancer (O/E 1.83 CI: 1.65- 2.03; N= 363) that stays high even at 10 years. Conclusions: Using a large population based data base we show increasing incidence of stage I lung cancer. There was no change in observed 5 year survival for the time period selected. We also show higher incidence of second malignancies persisting many years after their initial diagnosis of lung cancer. This information might help evaluate various risk modification and screening strategies to improve survival.