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Heudel PE, de Montfort A, Debieuvre D, Chouaid C, Carton M, Audigier-Valette C, Filleron T, Chabaud S, Stancu A, Quantin X, Hiret S, Bosquet L, Blay JY. Reduced risk of secondary primary extra pulmonary cancer in advanced/metastatic lung cancer patients treated with immune checkpoint inhibitors. Lung Cancer 2023; 182:107280. [PMID: 37339550 DOI: 10.1016/j.lungcan.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Lung cancer survivors are at high risk of developing a second primary cancer (SPC). We explored the Unicancer Epidemiology Strategy Medical-Economics for advanced or metastatic lung cancer (AMLC) database to assess the impact of immune checkpoint inhibitors (ICI) on the risk of SPC in patients with advanced/metastatic lung cancer. PATIENTS AND METHODS This retrospective study used data from patients with AMLC, with treatment initiated between January 1st 2015 and December 31st 2018. Patients with lung cancer as the second primary cancer were excluded and a 6-months landmark threshold was applied to exclude patients with synchronous SPC, patients dead without SPC or with a follow-up inferior to 6 months. A propensity score (PS) was calculated on the following baseline covariates: Age at locally advanced or metastatic diagnosis, sex, smoking status, metastatic status, performance status and histological type. The inverse probability of treatment weighting approach was used on the analyses aiming to assess the impact of ICI administered for AMLC, on the risk of occurrence of SPC. RESULTS Among the 10 796 patients, 148 (1.4%) patients had a diagnosis of SPC in a median interval of 22 (min-max: 7-173) months. All the patients (100%) with locally advanced or metastatic LC received at least one systemic treatment including (chemotherapy regimen (n = 9 851, 91.2%); ICI (n = 4 648, 43.0%); targeted treatment (n = 3 500; 32.4%). 40 (0.9%) SPC were reported in the 4 648 patients with metastatic LC treated with ICI vs 108 (1.7%) out of the 6 148 who did not receive immunotherapy (p < 0.0001). The multivariate analysis identified that treatment with ICI in patients with AMLC is associated with a reduced risk of SPC (HR = 0.40, 95% CI 0.27-0.58). CONCLUSION Treatment with ICI in AMLC patients was associated with a significantly reduced risk of SPC. Prospective studies are required to confirm these results.
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Affiliation(s)
| | - A de Montfort
- Biostatistical Unit, Centre Léon Bérard, Lyon, France
| | - D Debieuvre
- Groupe hospitalier de la région de Mulhouse Sud Alsace, Mulhouse, France
| | - C Chouaid
- Centre hospitalier Intercommunal, Créteil, France
| | - M Carton
- Biostatistical Unit, Institut Curie, Paris, France
| | - C Audigier-Valette
- Centre hospitalier intercommunal de Toulon - La Seyne-sur-Mer, Toulon, France
| | - T Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Régaud IUCT-O, Toulouse, France
| | - S Chabaud
- Biostatistical Unit, Centre Léon Bérard, Lyon, France
| | - A Stancu
- Institut Sainte Catherine, Avignon, France
| | - X Quantin
- Institut régional du cancer, Montpellier, France
| | - S Hiret
- Institut de cancérologie de l'Ouest, Angers&Nantes, France
| | - L Bosquet
- Health Data and Partnership Department, Unicancer, Paris, France
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
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van Tilburg L, van de Ven SEM, Spaander MCW, van Kleef LA, Cornelissen R, Bruno MJ, Koch AD. Prevalence of lung tumors in patients with esophageal squamous cell carcinoma and vice versa: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2022; 149:1811-1823. [PMID: 35737094 PMCID: PMC10097754 DOI: 10.1007/s00432-022-04103-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Recent reports suggest an increased prevalence of lung second primary tumors (LSPTs) in esophageal squamous cell carcinoma (ESCC) patients and vice versa. However, the exact prevalence of SPTs remains unclear and screening for these SPTs is currently not routinely performed in western countries. We aimed to report on the prevalence of LSPTs in patients with ESCC and esophageal second primary tumors (ESPTs) in patients with lung cancer (LC). METHODS Databases were searched until 25 March 2021 for studies reporting the prevalence of LSPTs in ESCC or vice versa. Pooled prevalences with 95% confidence intervals (CI) of SPTs were calculated with inverse variance, random-effects models and Clopper-Pearson. RESULTS Nineteen studies in ESCC patients and 20 studies in LC patients were included. The pooled prevalence of LSPTs in patients with ESCC was 1.8% (95% CI 1.4-2.3%). For ESPTs in LC patients, the pooled prevalence was 0.2% (95% CI 0.1-0.4%). The prevalence of LSPTs in ESCC patients was significantly higher in patients treated curatively compared to studies also including palliative patients (median 2.5% versus 1.3%). This difference was consistent for the ESPT prevalence in LC patients (treated curatively median 1.3% versus 0.1% for all treatments). Over 50% of the detected SPTs were squamous cell carcinomas and were diagnosed metachronously. CONCLUSION Patients with ESCC and LC have an increased risk of developing SPTs in the lungs and esophagus. However, the relatively low SPT prevalence rates do not justify screening in these patients. Further research should focus on risk stratification to identify subgroups of patients at highest risk of SPT development.
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Affiliation(s)
- Laurelle van Tilburg
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Steffi E M van de Ven
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laurens A van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Eberl M, Tanaka LF, Kraywinkel K, Klug SJ. Incidence of smoking-related second primary cancers after lung cancer in Germany: an analysis of nationwide cancer registry data. J Thorac Oncol 2021; 17:388-398. [PMID: 34902598 DOI: 10.1016/j.jtho.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION About 80% of lung cancer cases in Germany are attributable to smoking. Patients with a lung cancer diagnosis may remain at increased risk of developing smoking-related second primary cancers (SPC). METHODS Anonymous data from 11 population-based cancer registries covering about 50% of the German population were pooled for the analysis. Included patients were diagnosed with an index lung cancer between 2002 and 2013, 30 to 99 years old at diagnosis and survived for at least 6 months. We calculated standardized incidence ratios (SIR) - stratified by age, sex, region and period - comparing the incidence of smoking-related and other SPC to the general population. RESULTS Of the 135,589 lung cancer survivors (68.2% male; mean follow-up 30.8 months) analyzed, 5,298 developed an SPC. In males the risk was particularly high for SPCs of the larynx (SIR = 3.70; 95% CI: 3.14-4.34), pharynx (3.17; 2.61-3.81) and oral cavity (2.86; 2.38-3.41). For females SIRs were notably elevated for esophagus (4.66; 3.15-6.66), oral cavity (3.14; 2.03-4.63) and urinary tract (2.68; 2.04-3.45). When combining all smoking-related cancer sites, SIR was 1.41 in males (95% CI: 1.36-1.47) and 1.81 in females (95% CI: 1.68-1.94). We observed that males had a 1.46-fold (95% CI: 1.37-1.56) and females a 1.33-fold (95% CI: 1.20-1.47) increased risk for smoking-related compared to other cancers. CONCLUSIONS Patients with primary lung cancer were at increased risk for developing a smoking-related SPC. Therefore, the advantages of increased patient surveillance and the benefits of smoking cessation strategies should be considered.
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Affiliation(s)
- Marian Eberl
- Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany.
| | - Luana F Tanaka
- Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
| | - Klaus Kraywinkel
- German Centre for Cancer Registry Data, Robert Koch-Institut, Nordufer 20, 13353 Berlin, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, TUM Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992 Munich, Germany
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Han C, Wu Y, Kang K, Wang Z, Liu Z, Zhang F. Long-term radiation therapy-related risk of second primary malignancies in patients with lung cancer. J Thorac Dis 2021; 13:5863-5874. [PMID: 34795935 PMCID: PMC8575836 DOI: 10.21037/jtd-21-915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/08/2021] [Indexed: 12/25/2022]
Abstract
Background With the improvement of cancer therapy, a second primary malignancy (SPM) occurs more commonly among cancer survivors. At present, it remains unclear whether the radiation therapy for the initial lung cancer will increase the risk of developing a SPM. This study aims to investigate the long-term risk of a SPM attributable to the radiation therapy in patients with the initial lung cancer. Methods Patients initially diagnosed with lung cancer between January 1975 and November 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. SPM was defined as the occurrence of a second cancer at least five years after the diagnosis of the initial lung cancer. Age- and propensity score matching (PSM)-adjusted competing risk analyses were performed to compare the risk of SPM. Results Of 47,911 patients, 9,162 (19.1%) underwent radiotherapy for the initial lung cancer. The PSM-adjusted competing risk analyses showed that radiation therapy was associated with a lower overall risk of SPM (HR: 0.89, 95% CI: 0.84-0.94, P<0.001). Specifically, the risk of second primary melanoma (HR: 0.49, 95% CI: 0.29-0.81, P=0.006), second primary female breast cancer (HR: 0.65, 95% CI: 0.50-0.85, P=0.001), second primary prostate cancer (HR: 0.69, 95% CI: 0.58-0.84, P<0.001) and second primary thyroid cancer (HR: 0.23, 95% CI: 0.07-0.77, P=0.017) was found to decrease, while the risk for second primary esophageal cancer dramatically increased (HR: 1.76, 95% CI: 1.26-2.45, P<0.001). Conclusions In patients who received radiotherapy for the initial lung cancer, the risk decreased for second primary melanoma as well as for second primary cancers of female breast, prostate and thyroid gland but increased for second primary cancer of esophagus. On the whole, radiation therapy for initial lung cancer may not increase the overall risk of SPM.
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Affiliation(s)
- Chang Han
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijun Wu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kai Kang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhile Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Song X, Hu Z, Tian Y, Guo Y. Does irradiation for initial primary lung cancer affect the risk of metachronous second primary lung cancer? RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:475-483. [PMID: 34191096 DOI: 10.1007/s00411-021-00923-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Several studies have reported inconsistent results about second primary lung cancer (SPLC) after irradiation for initial primary lung cancer (IPLC). The present study aims to assess the effect of ionising radiation on the risk of SPLC. The study population came from SEER database, and included a population-based cohort of 21,397 individuals diagnosed with IPLC between 2004 and 2009 who survived more than 7 years after the initial diagnosis. The first aim was to estimate the risk of SPLC in different periods and the cumulative risk of SPLC. Subsequently, a generalized additive model with Poisson regression analysis and a proportional sub-distribution hazard model was used to determine whether radiation affected the risk of SPLC. Until Dec 2016, there were 488 individuals who developed SPLC, 5368 individuals who died, and there were 15,541 alive individuals, respectively. The risk of SPLC was found to gradually decline with the extent of follow-up time. Age and histology were the two main risk factors of developing SPLC in Poisson regression and competing risk analyses. In Poisson regression analysis, radiation had no significant effect on the risk of developing SPLC (adjusted OR = 0.80, 95% CI 0.54, 1.19, P = 0.28). When considered competing risk of all-cause death, the risk of SPLC in the radiation group was similar to that in the non-radiation group (adjusted sHR = 0.80, 95% CI 0.56, 1.13, P = 0.21). The risk of SPLC was different during different follow-up time. Irradiation for IPLC seemingly did not affect the risk of developing SPLC.
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Affiliation(s)
- Xinyu Song
- Department of Respiratory and Critical Care Medicine, The First College of Clinical Medicine Science, Three Gorges University, NO. 183 Yiling Road, Yichang, 443003, People's Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People's Hospital, Yichang, People's Republic of China
| | - Zhigang Hu
- Department of Respiratory and Critical Care Medicine, The First College of Clinical Medicine Science, Three Gorges University, NO. 183 Yiling Road, Yichang, 443003, People's Republic of China.
- Department of Respiratory and Critical Care Medicine, Yichang Central People's Hospital, Yichang, People's Republic of China.
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.
| | - Yufeng Tian
- Department of Teaching Office, The First College of Clinical Medicine Science, China Three Gorges University, Yichang, People's Republic of China
| | - Yeqing Guo
- Department of Respiratory and Critical Care Medicine, The First College of Clinical Medicine Science, Three Gorges University, NO. 183 Yiling Road, Yichang, 443003, People's Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People's Hospital, Yichang, People's Republic of China
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Wu X, Zhang X, Tao L, Chen P. Risk of second primary malignancy in adults with pulmonary high-grade neuroendocrine carcinoma (HGNEC). BMC Cancer 2020; 20:719. [PMID: 32746796 PMCID: PMC7398247 DOI: 10.1186/s12885-020-07224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/27/2020] [Indexed: 12/09/2022] Open
Abstract
Background Pulmonary high-grade neuroendocrine carcinoma (HGNEC) has a rising incidence of developing second primary malignancies (SPMs). This study is the first population-based analysis to quantify the SPM risks among survivors of lung HGNEC. Methods We used the Surveillance, Epidemiology, and End Results (SEER) database to calculate standardized incidence ratio (SIR) and absolute excess risk (AER) between 2000 and 2016 for patients with pulmonary HGNEC. Results The data of 1161 patients with SPMs were retrieved from the SEER database. The ratio of observed/expected number of SPMs in pulmonary HGNEC was 1.53. Solid tumours comprised 91% of all second malignancies in lung HGNEC patients, with the most common cancers reported in the oral cavity and pharynx, the urinary and respiratory systems Conclusions Our study observed an increased risk of SPMs among patients with pulmongnancies.
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Affiliation(s)
- Xiaomin Wu
- Department of Oncology, Yancheng No.1 People's Hospital, the Affiliated Hospital of Nanjing University, 166 Yulong West Road, Yancheng, 224200, People's Republic of China
| | - Xiaojing Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou, 310000, People's Republic of China
| | - Leilei Tao
- Department of Oncology, Yancheng No.1 People's Hospital, the Affiliated Hospital of Nanjing University, 166 Yulong West Road, Yancheng, 224200, People's Republic of China
| | - Ping Chen
- Department of Oncology, Yancheng No.1 People's Hospital, the Affiliated Hospital of Nanjing University, 166 Yulong West Road, Yancheng, 224200, People's Republic of China.
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Ma B, Qin G, Zhang Y, Su C, Wu Z. Life-long follow-up of second primary lung and extra-pulmonary cancer in lung cancer patients is needed. J Cancer 2020; 11:4709-4715. [PMID: 32626517 PMCID: PMC7330703 DOI: 10.7150/jca.44581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/08/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Lung cancer (LC) patients are at high risk of developing second primary cancer (SPC). This study aimed to explore the risk factors associated with SPC and provide an individualized risk prediction model for LC patients. Methods: Initial primary lung cancer (IPLC) patients diagnosed between 1998 and 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. A Fine-Gray multivariate competing-risk model was used to estimate the risk of SPC, and the model was assessed regarding discrimination and calibration. A nomogram was designed for clinical convenience to predict the 3-, 5-, and 10- year probabilities of developing SPCs. Results: A total of 142,491 IPLC patients were considered in this study and 14,374(10.01%) developed SPC within a maximum study period of approximately 19 years. Seven independent prognostic factors were identified according to the competing-risk model, and the SEER summary stage and surgery were the strongest predictors. The model was well calibrated and had good discrimination ability(C-index = 0.746). Conclusions: LC survivors had an increased risk of SPC and factors associated with good prognosis often predicted SPC. Consideration should be given to increasing the duration of routine follow-up even after 10 years of initial diagnosis for those at the highest risk and site-specific follow-up strategy is also required.
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Affiliation(s)
- Bingqing Ma
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Yue Zhang
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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Radiotherapy was associated with the lower incidence of metachronous second primary lung cancer. Sci Rep 2019; 9:19283. [PMID: 31848368 PMCID: PMC6917769 DOI: 10.1038/s41598-019-55538-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/29/2019] [Indexed: 12/25/2022] Open
Abstract
Our study aims to estimate the incidence of metachronous second primary lung cancer(SPLC) in initial primary lung cancer(IPLC) survivors and to determine whether radiotherapy affects the risk of metachronous SPLC in the first five years after the diagnosis of lung cancer. Incidence data of IPLC individuals who survived ≥2 years were obtained from SEER-18 database in 2004–2007. Joinpoint regression analysis and competing risk analysis were used to calculate the incidence of metachronous SPLC. Propensity score matching and decision analysis were available to estimate the effect of radiotherapy on metachronous SPLC. 264 of 11657 IPLC survivors with radiotherapy and 1090 of 24499 IPLC survivors without radiotherapy developed metachronous SPLC during 5-year follow-up, respectively. In joinpoint regression analysis, the 5-year incidence of metachronous SPLC in the radiotherapy group was lower than that in the nonradiotherapy group(2385 per 100,000 vs 4748 per 100,000, HR = 0.43,95% CI:0.39–0.47). Competing risk analysis showed that the survivors with radiotherapy were associated with the lower 5 year incidence of metachronous SPLC compared with those without radiotherapy(2.28% vs 4.47%, HR = 0.49,95% CI:0.43–0.57). Through propensity score matching, 4077 pairs of survivors were available to further study that radiotherapy potentially decreased the risk of developing metachronous SPLC with the adjustment of various factors(2.5% vs 3.3%, HR = 0.72, 95% CI:0.55–0.96). Decision analysis suggested that radiotherapy was a negative independent risk factor of metachronous SPLC with clinical net benefit in a range of risk thresholds (2% to 5%). Survivors of IPLC with radiotherapy likely had a low risk of metachronous SPLC during the first five years follow-up, especially non-small cell lung cancer.
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Keith RL, Blatchford PJ, Merrick DT, Bunn PA, Bagwell B, Dwyer-Nield LD, Jackson MK, Geraci MW, Miller YE. A Randomized Phase II Trial of Pioglitazone for Lung Cancer Chemoprevention in High-Risk Current and Former Smokers. Cancer Prev Res (Phila) 2019; 12:721-730. [PMID: 31308004 DOI: 10.1158/1940-6207.capr-19-0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/01/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
Lung cancer chemoprevention, especially in high-risk former smokers, has great potential to reduce lung cancer incidence and mortality. Thiazolidinediones prevent lung cancer in preclinical studies, and diabetics receiving thiazolidinediones have lower lung cancer rates which led to our double-blind, randomized, phase II placebo-controlled trial of oral pioglitazone in high-risk current or former smokers with sputum cytologic atypia or known endobronchial dysplasia. Bronchoscopy was performed at study entry and after completing 6 months of treatment. Biopsies were histologically scored, and primary endpoint analysis tested worst biopsy scores (Max) between groups; Dysplasia index (DI) and average score (Avg) changes were secondary endpoints. Biopsies also received an inflammation score. The trial accrued 92 subjects (47 pioglitazone, 45 placebo), and 76 completed both bronchoscopies (39 pioglitazone, 37 placebo). Baseline dysplasia was significantly worse for current smokers, and 64% of subjects had mild or greater dysplasia at study entry. Subjects receiving pioglitazone did not exhibit improvement in bronchial dysplasia. Former smokers treated with pioglitazone exhibited a slight improvement in Max, while current smokers exhibited slight worsening. While statistically significant changes in Avg and DI were not observed in the treatment group, former smokers exhibited a slight decrease in both Avg and DI. Negligible Avg and DI changes occurred in current smokers. A trend toward decreased Ki-67 labeling index occurred in former smokers with baseline dysplasia receiving pioglitazone. While pioglitazone did not improve endobronchial histology in this high-risk cohort, specific lesions showed histologic improvement, and further study is needed to better characterize responsive dysplasia.
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Affiliation(s)
- Robert L Keith
- Division of Pulmonary Sciences and Critical Care Medicine, Eastern Colorado VA Healthcare System, Rocky Mountain Regional VA Medical Center, Aurora, Colorado. .,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Patrick J Blatchford
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel T Merrick
- Division of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Paul A Bunn
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brandi Bagwell
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori D Dwyer-Nield
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mary K Jackson
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mark W Geraci
- Department of Medicine, IU School of Medicine, Indianapolis, Indiana
| | - York E Miller
- Division of Pulmonary Sciences and Critical Care Medicine, Eastern Colorado VA Healthcare System, Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Barclay ME, Lyratzopoulos G, Walter FM, Jefferies S, Peake MD, Rintoul RC. Incidence of second and higher order smoking-related primary cancers following lung cancer: a population-based cohort study. Thorax 2019; 74:466-472. [PMID: 30777897 PMCID: PMC6475108 DOI: 10.1136/thoraxjnl-2018-212456] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/16/2018] [Accepted: 01/02/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer 5-year survival has doubled over 15 years. Although the risk of second primary cancer is recognised, quantification over time is lacking. We describe the incidence of second and higher order smoking-related primary cancers in lung cancer survivors, identifying high-incidence groups and how incidence changes over time from first diagnosis. METHODS Data on smoking-related primary cancers (lung, laryngeal, head and neck, oesophageal squamous cell carcinoma and bladder) diagnosed in England between 2000 and 2014 were obtained from Public Health England National Cancer Registration and Analysis Service. We calculated absolute incidence rates and standardised incidence rate ratios, both overall and for various subgroups of second primary cancer for up to 10 years from the initial diagnosis of lung cancer, using Poisson regression. RESULTS Elevated incidence of smoking-related second primary cancer persists for at least 10 years from first lung cancer diagnosis with those aged 50 and 79 at first diagnosis at particularly high risk. The most frequent type of second malignancy was lung cancer although the highest standardised incidence rate ratios were for oesophageal squamous cell carcinoma (2.4) and laryngeal cancers (2.8) and consistently higher in women than in men. Over the last decade, the incidence of second primary lung cancer has doubled. CONCLUSION Lung cancer survivors have increased the incidence of subsequent lung, laryngeal, head and neck and oesophageal squamous cell carcinoma for at least a decade from the first diagnosis. Consideration should be given to increasing routine follow-up from 5 years to 10 years for those at highest risk, alongside surveillance for other smoking-related cancers.
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Affiliation(s)
- Matthew E Barclay
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Georgios Lyratzopoulos
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
- Department of Behavioural Science and Health, Epidemiology of Cancer Healthcare & Outcomes, University College London, London, UK
- Public Health England (PHE), National Cancer Registration and Analysis Service (NCRAS), London, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sarah Jefferies
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael D Peake
- Public Health England (PHE), National Cancer Registration and Analysis Service (NCRAS), London, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Robert C Rintoul
- Department of Oncology, University of Cambridge, Cambridge, UK
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Wu B, Cui Y, Tian J, Song X, Hu P, Wei S. Effect of second primary cancer on the prognosis of patients with non-small cell lung cancer. J Thorac Dis 2019; 11:573-582. [PMID: 30963002 DOI: 10.21037/jtd.2018.11.96] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Second primary cancer (SPC) is not a rare event for patients with non-small cell lung cancer (NSCLC), especially for those who survive for a longer period of time. This study was aimed to explore the effects of SPC on the survival of NSLCL patients. Methods A total of 241,805 patients with primary NSCLC were identified between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. The incidence of SPC and its effect on the overall survival (OS) and lung cancer-specific survival (LCSS) was explored and analyzed using Cox regression model with SPC being treated as a time-dependent covariate. Results The incidence of SPCs after the diagnosis of NSCLC was 6.4%, with the second primary lung cancer being the most common one (45.1%). About half of the SPCs (50.7%) occurred during the first year after the diagnosis of NSCLC. It seemed that patients who developed SPC late in the follow-up period tended to have poor prognosis. Multivariable analysis with Cox regression showed that the occurrence of SPC was a poor prognostic factor for patients with NSCLC [hazard ratio (HR), 1.298; 95% confidence interval (CI), 1.270-1.326; P=0.000], and it increased the risk of LCSS (versus no SPC, HR, 1.094; 95% CI, 1.066-1.123; P=0.000). Conclusions The occurrence of SPC after the diagnosis of NSCLC was not a rare event, and it indicated a poorer prognosis compared with patients without it. During the follow-up, attention should be paid to the screening of SPC especially the second primary lung cancer, and a rational surveillance policy should be formed and implemented.
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Affiliation(s)
- Bingqun Wu
- Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing 100016, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jintao Tian
- Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing 100016, China
| | - Xiaoping Song
- Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing 100016, China
| | - Pengcheng Hu
- Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing 100016, China
| | - Shenhai Wei
- Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing 100016, China
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Abdel-Rahman O, Cheung WY. Subsequent thoracic cancers among patients diagnosed with lung cancer: a SEER database analysis. Curr Med Res Opin 2017; 33:2009-2017. [PMID: 28532174 DOI: 10.1080/03007995.2017.1333953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Population-based data on the development of subsequent thoracic cancers following the initial diagnosis of lung cancer are scarce. We evaluated this clinical scenario in lung cancer patients registered within the Surveillance, Epidemiology and End Results (SEER) database. METHODS The SEER database (1988-2013) was queried using the SEER*Stat program to determine the clinico-pathological features of lung cancer patients who develop subsequent thoracic cancers as well as the characteristics of these subsequent cancers. Associations were ascertained with chi-squared tests and survival analysis was performed using Kaplan-Meier methods. Standardized incidence ratios (SIRs) were calculated to determine the risk of each type of subsequent cancer. RESULTS A total of 223,274 lung cancer patients were identified and included in the current study. In this cohort, 6387 patients developed subsequent thoracic cancers. The following were associated with a higher likelihood of second cancers: female gender, younger age, white race, adenocarcinoma histology, married, lower AJCC stage, earlier year of diagnosis and local treatment with surgery rather than radiotherapy (p < .0001 for all parameters). In the subset of patients with subsequent thoracic cancers, survival was best for patients with second primary breast cancer followed by patients with lung or esophageal cancer (p < .0001). SIR analyses showed an excess risk for the development of esophageal cancer and second primary lung cancer following an initial diagnosis of lung cancer. This risk persists regardless of gender or receipt of radiotherapy (p < .05 for all scenarios). CONCLUSION There is an excess risk for the development of esophageal cancer and second primary lung cancer following an initial lung cancer diagnosis. This risk is present irrespective of gender or receipt of radiotherapy.
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Affiliation(s)
- Omar Abdel-Rahman
- a Clinical Oncology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | - Winson Y Cheung
- b Department of Oncology , University of Calgary, Tom Baker Cancer Centre , Calgary , Alberta , Canada
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