Prognostic factors of lung cancer in lymphoma survivors (the LuCiLyS study)

Abstract

Background: Second cancer is the leading cause of death in lymphoma survivors, with lung cancer representing the most common solid tumor. Limited information exists about the treatment and prognosis of second lung cancer following lymphoma. Herein, we evaluated the outcome and prognostic factors of Lung Cancer in Lymphoma Survivors (the LuCiLyS study) to improve the patient selection for lung cancer treatment.

Methods: This is a retrospective multicentre study including consecutive patients treated for lymphoma disease that subsequently developed non-small cell lung cancer (NSCLC). Data regarding lymphoma including age, symptoms, histology, disease stage, treatment received and lymphoma status at the time of lung cancer diagnosis, and data on lung carcinoma as age, smoking history, latency from lymphoma, symptoms, histology, disease stage, treatment received, and survival were evaluated to identify the significant prognostic factors for overall survival.

Results: Our study population included 164 patients, 145 of which underwent lung cancer resection. The median overall survival was 63 (range, 58-85) months, and the 5-year survival rate 54%. At univariable analysis no-active lymphoma (HR: 2.19; P=0.0152); early lymphoma stage (HR: 1.95; P=0.01); adenocarcinoma histology (HR: 0.59; P=0.0421); early lung cancer stage (HR: 3.18; P<0.0001); incidental diagnosis of lung cancer (HR: 1.71; P<0.0001); and lung cancer resection (HR: 2.79; P<0.0001) were favorable prognostic factors. At multivariable analysis, no-active lymphoma (HR: 2.68; P=0.004); early lung cancer stage (HR: 2.37; P<0.0001); incidental diagnosis of lung cancer (HR: 2.00; P<0.0001); and lung cancer resection (HR: 2.07; P<0.0001) remained favorable prognostic factors. Patients with non-active lymphoma (n=146) versus those with active lymphoma (n=18) at lung cancer diagnosis presented better median survival (64 vs. 37 months; HR: 2.4; P=0.02), but median lung cancer specific survival showed no significant difference (27 vs. 19 months; HR: 0.3; P=0.17).

Conclusions: The presence and/or a history of lymphoma should not be a contraindication to resection of lung cancer. Inclusion of lymphoma survivors in a lung cancer-screening program may lead to early detection of lung cancer, and improve the survival.

Keywords: Lymphoma; lung cancer; second primary tumor.

Figure 1

The median overall survival after diagnosis of lung cancer was 63 (range, 58–85) months.

Figure 2

No significant difference was found among patients groups stratified according to age at lymphoma diagnosis (P=0.20; Part A); Non-Hodgkin lymphoma histology (P=0.11, Part B); lymphoma stage (P=0.08; Part C); and lymphoma treatment (P=0.56; Part D).

Figure 3

No significant difference was found among patients stratified according to age at lung cancer diagnosis (P=0.17; Part A); latency between lymphoma and lung cancer diagnosis (P=0.07; Part B); and different type of resections (P=0.23; Part D), while significant difference was found among patients stratified according to lung cancer stage (P<0.0001; Part C).

Figure 4

Patients with lymphoma in remission compared with those with active lymphoma presented significant better survival [64 (range, 59–85) vs. 37 (range, 13–75) months; HR: 2.4; P=0.02; Part A], but lung cancer specific survival showed no significant difference [27 (range, 18–85) vs. 19 (range, 13–37) months; HR: 0.3; P=0.17; Part B].