Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC
Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC
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DOI：
10.1016/j.lungcan.2019.09.001
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发表时间：
2019-11-01
期刊：
影响因子：
5.3
通讯作者：
Westeel, Virginie
中科院分区：
文献类型：
--
作者：
Leroy, Taylor;Monnet, Elisabeth;Westeel, Virginie
目的：一些研究报道了非小细胞肺癌（NSCLC）手术患者发生第二原发性肺癌（SPLC）的高风险。然而，对这一风险的估计存在很大差异，很少有研究考虑到这些患者由于初始疾病的复发和合并症而具有特别高的竞争死亡风险。随着时间的推移，风险因素评估对非小细胞肺癌的术后监测策略有重要影响。本研究主要是通过考虑竞争死亡风险的统计方法，在长期随访系列中测量SPLC的风险。材料和方法：根据Doubs和Belfort癌症登记处（法国）2002年至2015年间诊断为完全切除的i - ii期非小细胞肺癌患者的累积发病率，估计累积SPLC风险。在存在竞争风险的情况下，采用比例亚分布风险模型（sdRH）研究与SPLC风险相关的因素。结果：522例患者中，腺癌和I、II期疾病分别占52.3%和75.7%。总体而言，84例患者发生SPLC（16.1%）。术后10年SPLC累积风险为20.2%(95%可信区间[CI]: 15.3-23.2)，术后14年累积风险为25.2% （CI: 19.4-31.3）。多因素分析显示，术后胸部放疗患者发生SPLC的风险显著增高（saRH 2.79; 95% CI: 1.41-5.52; p = 0.003）。结论：本研究采用适当的统计学方法考虑竞争风险，发现NSCLC完全切除后，SPLC的累积发生率函数较高，术后接受胸部放疗的患者风险较高。这些数据支持对接受非小细胞肺癌手术的患者进行终身随访的必要性，目的是筛查SPLC。
Objectives: Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death.Materials and methods: The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-Ill NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks.Results: Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (saRH 2.79; 95% CI: 1.41-5.52; p = 0.003).Conclusion: This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.