Clinical outcomes of patients with metachronous second primary lung adenocarcinomas

Abstract

BackgroundThe incidence of adenocarcinomas as multiple primary lung cancers (MPLCs) is increasing. How to determine the treatment strategies of MPLCs, especially second primary lung adenocarcinomas (SPLACs), and the prognostic factors associated with it are unclear.MethodsThe clinical records of patients undergoing surgery for second adenocarcinomas based on Martini–Melamed criteria between 2001 and 2014 were retrospectively reviewed. Survival rates were calculated by the Kaplan–Meier method and compared using the log-rank test. Multivariate analysis was conducted using the Cox proportional hazards model.ResultsA total of 115 patients with SPLACs were identified based on Martini–Melamed criteria. With respect to the second resections, three subgroups with low- (adenocarcinoma in situ, n=6; minimally invasive adenocarcinoma, n=19), intermediate- (lepidic, n=9; acinar, n=40; papillary, n=23), and high-grades (solid, n=9; micropapillary, n=2; invasive mucinous, n=7) were assigned. The 5-year overall survival (OS) rates from the time of the first and the second resections were 86.5% and 69.5%, respectively. Cox multivariate analysis identified computed tomography (CT) morphology of SPLACs (ground glass opacity predominant versus solid predominant; hazard ratio [HR]=0.42; P=0.036), histologic classification (same/similar vs different; HR=0.06; P<0.001), pathologic stage of the primary (stage I vs II; HR=0.20; P=0.015) and second tumors (stage I vs IIIa; HR=0.21; P=0.002), and histologic grade of SPLACs (low- vs high-grade, HR=0.05, P=0.016; intermediate- vs high-grade, HR=0.37, P=0.027) as significantly favorable prognostic factors for OS.ConclusionIn addition to pathologic stage of the initial tumors and histologic classification, pathologic stage and CT morphology of SPLACs were identified as predictors of survival. The histologic grade of SPLACs based on the new adenocarcinoma classification could provide additional prognostic information.

Lobectomy Versus Sublobectomy in Metachronous Second Primary Lung Cancer: A Propensity Score Study

“…Second, the SEER database did not include details on pulmonary function and associated medical comorbidities and surgical approaches (open or minimally invasive), which made it difficult to identify for further analysis the patients at high risk. However, we have noted that some previous studies did not report the prognostic significance of the pulmonary functions [8,9,28]. More studies and larger cohorts are needed to study the value of different operations for advanced diseases.…”

“…Surgical type of the first cancer was not a significant prognostic factor in this cohort. As for lobectomy and sublobectomy in the first cancer treatment, Zhao and colleagues [28] found no significant prognostic difference between them for the first cancer. van Rens and colleagues [22] also did not report the different effect of lobectomy and limited resection for the first cancer on overall survival.…”

Clinical features and outcomes of patients with stage I multiple primary lung cancers

“…6,7 Although surgical resection becomes necessary to prolong patients' survival, controversies related to diagnosis, patient selection, treatment, and outcomes still exist. 8 Although surgery offers the best chance for potential cure of MPLC and provides the most sufficient samples for diagnosis, 9 the prognosis of MPLC after surgery has not been studied in detail. In this study, the aim was to identify factors related to MPLC treatment outcomes, as well as the clinical features of affected patients, using the database of cases of surgically resected NSCLC cases in the year 2010 compiled by the JJCLCR.…”

Outcomes after Contralateral Anatomic Surgical Resection in Multiple Lung Cancer

“…Several authors have reported early and late outcomes in patients with multiple synchronous 5,9-13 or metachronous [14][15][16] lung cancers. These studies evaluated ipsilateral and contralateral multiple primary lung cancers, often considering data for both these situations, but few studies have specifically described outcomes following contralateral surgical resection.…”