Clinical Study on Lung Cancer as a Second Primary Cancer

Abstract

This study evaluates the effect of a previous cancer on the clinical characteristics and the outcome of lung cancer patients. The 313 primary lung cancer patients operated on in the Osaka University Hospital during the period 1984-1993 were reviewed. Of those, 37 had a history of previous cancer. In the lung cancer patients with a history of previous cancer, 20 had adenocarcinomas, 14 had squamous cell carcinomas, while 3 had other cancers. The previous malignancies included 13 gastric cancers, 10 head and neck cancers, 6 colorectal cancers, and 8 others. The pathological stage was 17 stage I, 1 stage II, 15 stage IIIA, 1 stage IIIB, and 3 stage IV. The 5-year survival rate was 37.9%. In patients without a history of previous cancer, there were 139 adenocarcinomas, 100 squamous cell carcinomas, and 37 others. The pathological stage was 126 stage I, 33 stage II, 74 stage IIIA, 23 stage IIIB, and 20 stage IV. The 5-year survival rate was 43.3%. There were no significant differences in the cell type, stage, or survival between the lung cancers found as the first and second cancers. Lung cancer patients with a history of previous cancer are expected to respond to a resection as well as those with lung cancer appearing as their first cancer.

Estimating lead‐time bias in lung cancer diagnosis of patients with previous cancers

“…Yet surprisingly, several studies have reported that among newly diagnosed lung cancer patients aged 66 and older, those with a previous cancer do not have worse survival than those with no previous diagnosis; indeed, they often do better. For example, Laccetti et al observed that among patients with a newly diagnosed stage IV lung cancer, those with a previous cancer diagnosis had longer all‐cause survival and lung cancer–specific survival than similar patients who had not had a previous cancer. …”

Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual

“…In a single-center series of 1914 lung cancer patients, of whom 228 (12%) had a history of at least one previous malignancy, no survival detriment was observed in the group with prior cancer (HR = 0.84, 95% CI = 0.70 to 1.01) (22). A number of smaller studies reported similar trends (24,26,27,39). Conversely, in a study of 2991 patients with resected stage I NSCLC, the subset of 192 patients with prior cancer (6%) had statistically significantly inferior survival (HR = 1.44, 95% CI = 1.16 to 1.78) (23).…”

“…Earlier studies investigating the impact of a prior cancer diagnosis on lung cancer outcomes yielded conflicting findings and primarily focused on resected, early-stage lung cancer (22)(23)(24)(25)(26)(27)39). In a single-center series of 1914 lung cancer patients, of whom 228 (12%) had a history of at least one previous malignancy, no survival detriment was observed in the group with prior cancer (HR = 0.84, 95% CI = 0.70 to 1.01) (22).…”

“…However, studies evaluating the impact of prior cancer on lung cancer outcomes yield conflicting results, are predominantly small, single-center series, and primarily focus on resected, early-stage tumors (22)(23)(24)(25)(26)(27). We therefore determined the prevalence and prognostic impact of prior cancers among patients with advanced lung cancer using a large, representative, population-based, clinically detailed dataset.…”

Impact of prior cancer on eligibility for lung cancer clinical trials.

“…Despite these concerns, relatively little is known about the prognostic impact of a prior cancer diagnosis and the appropriateness of this commonplace exclusion criterion. In lung cancer, almost all of the published literature is limited to earlystage resected tumors, and results are conflicted (23)(24)(25). Even less is known about prior cancer diagnoses in patients with locally advanced or metastatic lung cancer, a group accounting for twothirds of all lung cancers and representing the target population of 94% of the lung cancer trials reviewed here.…”