The Survival Impact of Second Primary Lung Cancer in Patients With Lung Cancer.
The Survival Impact of Second Primary Lung Cancer in Patients With Lung Cancer.
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DOI：
10.1093/jnci/djab224
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发表时间：
2022-04-11
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肺癌幸存者发展为第二原发性肺癌（SPLC）的风险很高，但对SPLC诊断对生存的影响知之甚少。我们分析了来自监测、流行病学和最终结果（SEER）的138969例患者的数据，这些患者在1988-2013年间因原发性肺癌（IPLC）接受了手术治疗。每位患者从IPLC诊断至SPLC诊断（SPLC患者）和最后生命状态随访至2016年。我们采用多变量Cox回归来评估总生存率与SPLC诊断之间作为时变预测因子的相关性。为了研究潜在的效应改变，我们测试了SPLC和IPLC阶段之间的相互作用。使用来自多民族队列研究（MEC）的数据（n = 1540例手术的IPLC患者），我们评估了吸烟状况对SPLC生存的影响。所有统计检验均为双侧检验。在700 421人年的随访中，共有12115例（8.7%）患者在SEER中发生SPLC。与单一原发性肺癌患者相比，SPLC患者的总生存率有统计学意义（风险比[HR] = 2.12, 95%可信区间[CI] = 2.06 ~ 2.17; P < .001）。SPLC对早期IPLC患者生存率降低的影响比晚期IPLC患者更明显（HR = 2.14, 95% CI = 2.08 ~ 2.20, HR = 1.43, 95% CI = 1.21 ~ 1.70， p互作用< .001）。MEC数据分析显示，与以前或从不吸烟的患者相比，初次诊断时积极吸烟的患者SPLC对生存率降低的影响具有统计学意义（HR = 2.31, 95% CI = 1.48至3.61,HR = 1.41, 95% CI = 0.98至2.03；p交互作用= 0.04）。在SEER和MEC中，SPLC诊断与生存率降低有统计学意义。在IPLC诊断时，针对早期IPLC和主动吸烟的患者进行强化监测可能会带来更大的生存益处。
Lung cancer survivors have a high risk of developing second primary lung cancer (SPLC), but little is known about the survival impact of SPLC diagnosis. We analyzed data from 138 969 patients in the Surveillance, Epidemiology, and End Results (SEER), who were surgically treated for initial primary lung cancer (IPLC) in 1988-2013. Each patient was followed from the date of IPLC diagnosis to SPLC diagnosis (for those with SPLC) and last vital status through 2016. We performed multivariable Cox regression to evaluate the association between overall survival and SPLC diagnosis as a time-varying predictor. To investigate potential effect modification, we tested interaction between SPLC and IPLC stage. Using data from the Multiethnic Cohort Study (MEC) (n = 1540 IPLC patients with surgery), we evaluated the survival impact of SPLC by smoking status. All statistical tests were 2-sided. A total of 12 115 (8.7%) patients developed SPLC in SEER over 700 421 person-years of follow-up. Compared with patients with single primary lung cancer, those with SPLC had statistically significantly reduced overall survival (hazard ratio [HR] = 2.12, 95% confidence interval [CI] = 2.06 to 2.17; P < .001). The effect of SPLC on reduced survival was more pronounced among patients with early stage IPLC vs advanced-stage IPLC (HR = 2.14, 95% CI = 2.08 to 2.20, vs HR = 1.43, 95% CI = 1.21 to 1.70, respectively; Pinteraction < .001). Analysis using MEC data showed that the effect of SPLC on reduced survival was statistically significantly larger among persons who actively smoked at initial diagnosis vs those who formerly or never smoked (HR = 2.31, 95% CI = 1.48 to 3.61, vs HR = 1.41, 95% CI = 0.98 to 2.03, respectively; Pinteraction = .04). SPLC diagnosis is statistically significantly associated with decreased survival in SEER and MEC. Intensive surveillance targeting patients with early stage IPLC and active smoking at IPLC diagnosis may lead to a larger survival benefit.