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Comparative Study
. 2014 Sep;98(3):968-74.
doi: 10.1016/j.athoracsur.2014.04.098. Epub 2014 Jul 16.

Second primary lung cancers: smokers versus nonsmokers after resection of stage I lung adenocarcinoma

R Taylor Ripley  1 , Robert R McMillan  1 , Camelia S Sima  1 , Saad M Hasan  1 , Usman Ahmad  1 , Feiran Lou  1 , David R Jones  1 , Valerie W Rusch  1 , Nabil P Rizk  1 , James Huang  2
Affiliations
Comparative Study

Second primary lung cancers: smokers versus nonsmokers after resection of stage I lung adenocarcinoma

R Taylor Ripley et al. Ann Thorac Surg. 2014 Sep.

Abstract

Background: Smokers have a higher risk of developing non-small cell lung cancer (NSCLC) than never-smokers, but the relative risk of developing second primary lung cancer (SPLC) is unclear. Determining the risk of SPLC in smokers versus never-smokers after treatment of an initial cancer may help guide recommendations for long-term surveillance.

Methods: Patients who underwent resection for stage I adenocarcinoma were identified from a prospectively maintained institutional database. Patients with other histologies, synchronous lesions, or who received neoadjuvant or adjuvant therapy were excluded. The SPLCs were identified based on Martini criteria.

Results: From 1995 to 2012, a total of 2,151 patients underwent resection for stage I adenocarcinoma (308 never-smokers [14%] and 1,843 ever-smokers [86%]). SPLC developed in 30 never-smokers (9.9%) and 145 ever-smokers (7.8%). The SPLC was detected by surveillance computed tomography scan in the majority of patients (161; 92%). In total, 87% of never-smokers and 83% of ever-smokers had stage I SPLC. There was no significant difference in the cumulative incidence of SPLC between never-smokers and ever-smokers (p = 0.18) in a competing-risks analysis. The cumulative incidence at 10 years was 20.3% for never-smokers and 18.2% for ever-smokers.

Conclusions: Although smokers have a greater risk of NSCLC, the risk of a second primary cancer developing after resection of stage I lung cancer is comparable between smokers and never-smokers. The majority of these second primary cancers are detectable at a curable stage. Ongoing postoperative surveillance should be recommended for all patients regardless of smoking status.

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Figures

Figure 1
Figure 1
Competing-risks analysis of the cumulative incidence of second primary lung cancer (p=0.16) by smoking status.
Figure 2
Figure 2
Kaplan-Meier graph of overall survival for patients after resection of stage IA or IB adenocarcinoma by smoking status (p=0.014).
Figure 3
Figure 3
Kaplan-Meier graph of overall survival for patients after treatment of second primary lung cancer by smoking status (p=0.18).
See this image and copyright information in PMC

References

    1. Siegel R, DeSantis C, Virgo K, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62:220–241. - PubMed
    1. Samet JM, Avila-Tang E, Boffetta P, et al. Lung cancer in never smokers: clinical epidemiology and environmental risk factors. Clin Cancer Res. 2009;15:5626–5645. - PMC - PubMed
    1. Sisti J, Boffetta P. What proportion of lung cancer in never-smokers can be attributed to known risk factors? Int J Cancer. 2012;131:265–275. - PMC - PubMed
    1. Mountzios G, Fouret P, Soria JC. Mechanisms of disease: signal transduction in lung carcinogenesis―a comparison of smokers and never-smokers. Nat Clin Pract Oncol. 2008;5:610–618. - PubMed
    1. Varghese AM, Sima CS, Chaft JE, et al. Lungs don't forget: comparison of the KRAS and EGFR mutation profile and survival of collegiate smokers and never smokers with advanced lung cancers. J Thorac Oncol. 2013;8:123–125. - PMC - PubMed

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