The clinical-histologic and prognostic characteristics in patients with a second primary non-small-cell lung cancer after a lobectomy

Lei-Lei Wu; Rang-Rang Wang; Jia-Yi Qian; Yu'e Liu; Shang-Shang Ma; Ming-Jun Li; Long-Yan Xie; Zhi-Xin Li; Kun Li; Bing-Yong Sheng; Jun-Rong Ding; Dong Xie

doi:10.1093/icvts/ivad155

The clinical-histologic and prognostic characteristics in patients with a second primary non-small-cell lung cancer after a lobectomy

Interdiscip Cardiovasc Thorac Surg. 2023 Sep 2;37(3):ivad155. doi: 10.1093/icvts/ivad155.

Authors

Lei-Lei Wu¹, Rang-Rang Wang^{2

3}, Jia-Yi Qian¹, Yu'e Liu⁴, Shang-Shang Ma⁴, Ming-Jun Li⁴, Long-Yan Xie⁴, Zhi-Xin Li¹, Kun Li¹, Bing-Yong Sheng⁵, Jun-Rong Ding¹, Dong Xie¹

Affiliations

¹ Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, P. R. China.
² Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, P. R. China.
³ Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China.
⁴ School of Medicine, Tongji University, Shanghai, 200092, P. R. China.
⁵ Radiology Department, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, P. R. China.

Abstract

Objectives: The goal of this study was to investigate whether an operation can offer survival benefits for patients with a second primary non-small-cell lung cancer (NSCLC) after a lobectomy for a first primary NSCLC and to analyse the characteristics affecting the survival of those patients.

Methods: We performed survival analyses of patients with a second primary NSCLC based on the Surveillance, Epidemiology and End Results program and used propensity score matching to reduce the potential bias and analyse the data. In addition, the primary observational end point was overall survival (OS), and the secondary observational end point was histologic migration.

Results: The data from 944 patients were used to perform the main analysis. A total of 36.2% of patients experienced a shift in tumour histologic type between 2 diagnoses of primary NSCLC, and this shift significantly affected OS (P = 0.0065). The median survival time in patients with surgical resection and those without an operation was 52.0 months versus 33.0 months, respectively. Patients with surgical resection at the secondary diagnosis had better survival than those without surgery (5-year OS rate: 48.0% vs 34.0%, P < 0.001). In addition, compared with a pneumonectomy and a sublobar resection, a lobectomy was the optimal surgical procedure for patients diagnosed with a second primary NSCLC after adjusting for other confounders (adjusted hazard ratio: 0.68, P < 0.01). However, in the subgroup analysis, lobar and sublobar resections could provide similar survival benefits for patients with tumour size ≤20 mm (P = 0.5).

Conclusions: The operation, especially a lobectomy, can prolong OS in patients with a second primary NSCLC. Besides, sublobar resection can be performed in selected patients with tumour size ≤20 mm. Moreover, histologic migration may impact the survival of those patients with a secondary primary NSCLC.

Keywords: Second primary lung cancer; histology migration; propensity-score matching; surgical treatment.

Abstract

Grants and funding