Mortality of lung cancer as a second primary malignancy: A population-based cohort study

Lei Deng, Hrönn Harðardottír, Huan Song, Zhengrui Xiao, Changchuan Jiang, Qian Wang, Unnur Valdimarsdóttir, Haiying Cheng, Billy W. Loo, Donghao Lu

Research output: Contribution to journalArticle

Abstract

Lung cancer as a second primary malignancy (lung-2) is increasingly common, but its prognosis is poorly understood. This study aims to examine the overall and cancer-specific survival of patients diagnosed with lung-2 compared to lung-1. Primary lung cancer patients diagnosed from 1988 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) program were included. Lung-2 was identified in patients with a previous diagnosis of nonlung primary malignancy in SEER. Hazard ratios (HRs) of overall and lung cancer-specific mortality were estimated among patients with lung-2 compared to lung-1, adjusting for age and calendar period at diagnosis, sex, race, socioeconomic status, tumor stage, histology, tumor grade, and treatment. A total of 679 541 and 85 758 patients were identified as lung-1 and lung-2, respectively. Compared to lung-1, patients with lung-2 were more likely to be diagnosed at localized stage, with smaller primary tumor, and treated with surgery. Lung-2 patients were at lower risk of lung cancer-specific mortality in the first 5 years (HR, 0.77; 95% CI, 0.76-0.78 at <1 year; HR, 0.87; 95% CI, 0.86-0.89 from 1 to <5 years) but at higher risk thereafter (HR, 1.32; 95% CI, 1.27-1.37 from 5 to 10 years), independent of tumor characteristics and cancer treatment. Similar pattern was found for overall mortality, although the survival benefit was restricted to the first year after diagnosis. Patients diagnosed with lung-2 face a favorable lung cancer-specific survival within the early period after diagnosis. A conservative approach to manage lung-2 solely based on malignancy history is not supported.

Original languageEnglish (US)
Pages (from-to)3269-3277
Number of pages9
JournalCancer Medicine
Volume8
Issue number6
DOIs
StatePublished - Jun 1 2019

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Second Primary Neoplasms
Lung Neoplasms
Cohort Studies
Lung
Mortality
Population
Neoplasms
Survival
SEER Program
Social Class
Histology
Epidemiology

Keywords

  • cohort study
  • lung cancer
  • mortality
  • prognosis
  • second primary

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Deng, L., Harðardottír, H., Song, H., Xiao, Z., Jiang, C., Wang, Q., ... Lu, D. (2019). Mortality of lung cancer as a second primary malignancy: A population-based cohort study. Cancer Medicine, 8(6), 3269-3277. https://doi.org/10.1002/cam4.2172

Mortality of lung cancer as a second primary malignancy : A population-based cohort study. / Deng, Lei; Harðardottír, Hrönn; Song, Huan; Xiao, Zhengrui; Jiang, Changchuan; Wang, Qian; Valdimarsdóttir, Unnur; Cheng, Haiying; Loo, Billy W.; Lu, Donghao.

In: Cancer Medicine, Vol. 8, No. 6, 01.06.2019, p. 3269-3277.

Research output: Contribution to journalArticle

Deng, L, Harðardottír, H, Song, H, Xiao, Z, Jiang, C, Wang, Q, Valdimarsdóttir, U, Cheng, H, Loo, BW & Lu, D 2019, 'Mortality of lung cancer as a second primary malignancy: A population-based cohort study', Cancer Medicine, vol. 8, no. 6, pp. 3269-3277. https://doi.org/10.1002/cam4.2172
Deng L, Harðardottír H, Song H, Xiao Z, Jiang C, Wang Q et al. Mortality of lung cancer as a second primary malignancy: A population-based cohort study. Cancer Medicine. 2019 Jun 1;8(6):3269-3277. https://doi.org/10.1002/cam4.2172
Deng, Lei ; Harðardottír, Hrönn ; Song, Huan ; Xiao, Zhengrui ; Jiang, Changchuan ; Wang, Qian ; Valdimarsdóttir, Unnur ; Cheng, Haiying ; Loo, Billy W. ; Lu, Donghao. / Mortality of lung cancer as a second primary malignancy : A population-based cohort study. In: Cancer Medicine. 2019 ; Vol. 8, No. 6. pp. 3269-3277.
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abstract = "Lung cancer as a second primary malignancy (lung-2) is increasingly common, but its prognosis is poorly understood. This study aims to examine the overall and cancer-specific survival of patients diagnosed with lung-2 compared to lung-1. Primary lung cancer patients diagnosed from 1988 to 2014 in the Surveillance, Epidemiology, and End Results (SEER) program were included. Lung-2 was identified in patients with a previous diagnosis of nonlung primary malignancy in SEER. Hazard ratios (HRs) of overall and lung cancer-specific mortality were estimated among patients with lung-2 compared to lung-1, adjusting for age and calendar period at diagnosis, sex, race, socioeconomic status, tumor stage, histology, tumor grade, and treatment. A total of 679 541 and 85 758 patients were identified as lung-1 and lung-2, respectively. Compared to lung-1, patients with lung-2 were more likely to be diagnosed at localized stage, with smaller primary tumor, and treated with surgery. Lung-2 patients were at lower risk of lung cancer-specific mortality in the first 5 years (HR, 0.77; 95{\%} CI, 0.76-0.78 at <1 year; HR, 0.87; 95{\%} CI, 0.86-0.89 from 1 to <5 years) but at higher risk thereafter (HR, 1.32; 95{\%} CI, 1.27-1.37 from 5 to 10 years), independent of tumor characteristics and cancer treatment. Similar pattern was found for overall mortality, although the survival benefit was restricted to the first year after diagnosis. Patients diagnosed with lung-2 face a favorable lung cancer-specific survival within the early period after diagnosis. A conservative approach to manage lung-2 solely based on malignancy history is not supported.",
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