Second Primary Lung Cancer Among Lung Cancer Survivors Who Never Smoked.
Second Primary Lung Cancer Among Lung Cancer Survivors Who Never Smoked.
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DOI：
10.1001/jamanetworkopen.2023.43278
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发表时间：
2023-11-01
影响因子：
13.8
通讯作者：
Han, Summer S.
中科院分区：
文献类型：
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作者：
Choi, Eunji;Su, Chloe C.;Wu, Julie T.;Aredo, Jacqueline V.;Neal, Joel W.;Leung, Ann N.;Backhus, Leah M.;Lui, Natalie S.;Le Marchand, Loic;Stram, Daniel O.;Liang, Su-Ying;Cheng, Iona;Wakelee, Heather A.;Han, Summer S.
从不吸烟的肺癌幸存者发生第二原发性肺癌（SPLC）的风险是多少？在这项21114名参与者的队列研究中，吸烟者的10年累积原发性肺癌（IPLC）发病率是不吸烟者的7倍。然而，IPLC后累积的SPLC发病率在从不吸烟的肺癌幸存者中与曾经吸烟的肺癌幸存者一样高。这些发现强调了在从不吸烟的肺癌幸存者中确定SPLC的危险因素并制定有针对性的监测策略的必要性。本队列研究对从不吸烟和从不吸烟的肺癌幸存者的第二原发性肺癌发病率和疾病负担进行了定性和量化。在美国，不吸烟者的肺癌占所有肺癌的25%；最近的治疗进展提高了原发性肺癌（IPLC）患者的生存率，这些患者现在处于发展为第二原发性肺癌（SPLC）的高风险中。随着美国吸烟率的持续下降，更仔细地检查从不吸烟的患者的肺癌流行病学，包括他们患SPLC的风险是至关重要的。估计和比较从未吸烟和曾经吸烟的肺癌幸存者的累积SPLC发病率。这项基于人群的前瞻性队列研究使用了多民族队列研究（MEC）的数据，该研究在1993年4月18日至1996年12月31日期间招募了参与者，随访至2017年7月1日。符合条件的受试者年龄在45 - 75岁之间，基线时有完整的吸烟数据。通过监测、流行病学和最终结果登记处对这些参与者进行IPLC和进一步SPLC发展的随访。数据分析时间为2022年7月1日至2023年1月31日。MEC入组时从不吸烟与从不吸烟的对比。该研究有2个主要结局：(1)整个研究队列中10年累积IPLC发病率和IPLC患者10年累积SPLC发病率；(2)吸烟史的标准化发病率比（SIR）（以SPLC发病率除以IPLC发病率计算）。在211 414名MEC参与者中，7161名（3.96%）发展为IPLC，超过4 038 007人-年，163名（2.28%）发展为SPLC，超过16 470人-年。在IPLC患者中，队列入组时的平均（SD）年龄为63.6（7.7）岁，男性4031(56.3%)，女性3131（43.7%）。吸烟者10年累积IPLC发病率为2.40% (95% CI, 2.31%-2.49%)，是不吸烟者的7倍（0.34%,95% CI, 0.30%-0.37%）。然而，IPLC后的10年累积SPLC发病率在从不吸烟者中（2.84%,95% CI, 1.50%-4.18%）与从不吸烟者（2.72%,95% CI, 2.24%-3.20%）一样高，这导致从不吸烟者的SIR （14.50, 95% CI, 8.73-22.65）明显高于从不吸烟者（3.50,95% CI, 2.95-4.12）。研究结果表明，从不吸烟的肺癌幸存者的SPLC风险与曾经吸烟的IPLC患者的SPLC风险一样高，强调需要确定从不吸烟患者的SPLC风险因素并制定有针对性的监测策略。
What is the risk of developing second primary lung cancer (SPLC) among lung cancer survivors who have never smoked? In this cohort study of 211 414 participants, the cumulative 10-year incidence of initial primary lung cancer (IPLC) among ever-smokers was 7 times higher than for never-smokers. However, the cumulative SPLC incidence following IPLC was as high among lung cancer survivors who never smoked as those who ever smoked. These findings highlight the need to identify risk factors for SPLC among lung cancer survivors who never smoked and to develop a targeted surveillance strategy. This cohort study characterizes and quantifies second primary lung cancer incidence and disease burden among lung cancer survivors who never vs ever smoked. Lung cancer among never-smokers accounts for 25% of all lung cancers in the US; recent therapeutic advances have improved survival among patients with initial primary lung cancer (IPLC), who are now at high risk of developing second primary lung cancer (SPLC). As smoking rates continue to decline in the US, it is critical to examine more closely the epidemiology of lung cancer among patients who never smoked, including their risk for SPLC. To estimate and compare the cumulative SPLC incidence among lung cancer survivors who have never smoked vs those who have ever smoked. This population-based prospective cohort study used data from the Multiethnic Cohort Study (MEC), which enrolled participants between April 18, 1993, and December 31, 1996, with follow-up through July 1, 2017. Eligible individuals for this study were aged 45 to 75 years and had complete smoking data at baseline. These participants were followed up for IPLC and further SPLC development through the Surveillance, Epidemiology, and End Results registry. The data were analyzed from July 1, 2022, to January 31, 2023. Never-smoking vs ever-smoking exposure at MEC enrollment. The study had 2 primary outcomes: (1) 10-year cumulative incidence of IPLC in the entire study cohort and 10-year cumulative incidence of SPLC among patients with IPLC and (2) standardized incidence ratio (SIR) (calculated as the SPLC incidence divided by the IPLC incidence) by smoking history. Among 211 414 MEC participants, 7161 (3.96%) developed IPLC over 4 038 007 person-years, and 163 (2.28%) developed SPLC over 16 470 person-years. Of the participants with IPLC, the mean (SD) age at cohort enrollment was 63.6 (7.7) years, 4031 (56.3%) were male, and 3131 (43.7%) were female. The 10-year cumulative IPLC incidence was 2.40% (95% CI, 2.31%-2.49%) among ever-smokers, which was 7 times higher than never-smokers (0.34%; 95% CI, 0.30%-0.37%). However, the 10-year cumulative SPLC incidence following IPLC was as high among never-smokers (2.84%; 95% CI, 1.50%-4.18%) as ever-smokers (2.72%; 95% CI, 2.24%-3.20%), which led to a substantially higher SIR for never-smokers (14.50; 95% CI, 8.73-22.65) vs ever-smokers (3.50; 95% CI, 2.95-4.12). The findings indicate that SPLC risk among lung cancer survivors who never smoked is as high as among those with IPLC who ever-smoked, highlighting the need to identify risk factors for SPLC among patients who never smoked and to develop a targeted surveillance strategy.
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影响因子：
1.7
作者：
Gu, Kangxia;Ng, Hon Keung Tony;Schucany, William R.
通讯作者：
Schucany, William R.
影响因子：
9.7
作者：
Casal-Mourino, Ana;Ruano-Ravina, Alberto;Perez-Rios, Monica
通讯作者：
Perez-Rios, Monica
影响因子：
1
作者：
Beyersmann, Jan;Di Termini, Susanna;Pauly, Markus
通讯作者：
Pauly, Markus
影响因子：
254.7
作者：
Parkin, DM;Bray, F;Pisani, P
通讯作者：
Pisani, P
DOI：
10.1093/jnci/djab224
发表时间：
2022-04-11
期刊：
Journal of the National Cancer Institute
影响因子：
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作者：
通讯作者：
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