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. 2023 Sep 2;37(3):ivad155.
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

Lei-Lei Wu  1 , Rang-Rang Wang  2   3 , Jia-Yi Qian  1 , Yu'e Liu  4 , Shang-Shang Ma  4 , Ming-Jun Li  4 , Long-Yan Xie  4 , Zhi-Xin Li  1 , Kun Li  1 , Bing-Yong Sheng  5 , Jun-Rong Ding  1 , Dong Xie  1
Affiliations

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

Lei-Lei Wu et al. Interdiscip Cardiovasc Thorac Surg. .

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:
Flow chart for this study.
Figure 2:
Figure 2:
Survival analysis of patients with a second primary non-small-cell lung cancer before (A) and after (B) propensity score matching (the adjusted P values between subgroups were analysed using the Benjamini & Hochberg method).
Figure 3:
Figure 3:
Overall survival analysis of different surgical approaches in unmatched (A) and matched (B) cohorts.
Figure 4:
Figure 4:
Survival analysis of patients with tumour size ≤20 mm before (A) and after (B) matching.
Figure 5:
Figure 5:
(A) Sankey diagram of histologic migration; (B) Survival analysis of patients with pathological transformation or without non-pathological transformation. ADC: adenocarcinoma; NSCLC: non-small-cell lung cancer. SCC: squamous cell carcinoma
None
See this image and copyright information in PMC

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