Brock Malcolm V, Alberg Anthony J, Hooker Craig M, Kammer Anne L, Xu Li, Roig Carmen M, Yang Stephen C
Johns Hopkins Medical Institutions, Baltimore, MD, USA.
J Thorac Cardiovasc Surg. 2004 Apr;127(4):1119-25. doi: 10.1016/j.jtcvs.2003.10.039.
This study was performed to test the hypothesis that a history of other primary neoplasms before a lung cancer diagnosis increases the risk of subsequent malignancy.
Of 8363 lung cancer patients seen from 1978 to 2002, 881 (11%) had at least 1 previous nonlung primary malignancy. Charts were analyzed for the occurrence of subsequent malignancies.
Lung cancer diagnosis in 881 patients consisted of 75% non-small cell, 12% small cell, and 13% other histologies. The median age was 66 years, with 56% male, 76% white, and 86% smokers. Of the 881 patients, 92% had no subsequent cancer (group 1), and 8% went on to experience the development of a new primary neoplasm (including lung) after their lung cancer (group 2). After adequate follow-up, the cumulative probability of developing a subsequent cancer did not differ markedly between those with and without a prior non-lung cancer diagnosis at 2 years (12% vs 10%) or 5 years (16% vs 15%). Group 1 patients had a significantly lower 1- and 5-year survival than group 2 patients (59% vs 48% and 29% vs 17%, respectively; P =.008). Although multivariate analysis suggested that stage, history of tobacco-associated neoplasm, and history of definitive surgical resection were important determinants in predicting long-term survival, a prior malignancy was not an independent risk factor in the development of subsequent malignancy.
The risk of developing a subsequent malignancy is very high in lung cancer patients with prior primary malignancies, but it is not markedly different from the risks experienced by patients with no prior malignancies.
本研究旨在验证肺癌诊断前有其他原发性肿瘤病史会增加后续发生恶性肿瘤风险这一假设。
在1978年至2002年间就诊的8363例肺癌患者中，881例（11%）既往至少有1例非肺癌原发性恶性肿瘤。分析病历以了解后续恶性肿瘤的发生情况。
881例患者的肺癌诊断中，非小细胞肺癌占75%，小细胞肺癌占12%，其他组织学类型占13%。中位年龄为66岁，男性占56%，白人占76%，吸烟者占86%。881例患者中，92%无后续癌症（第1组），8%在肺癌后发生了新的原发性肿瘤（包括肺癌）（第2组）。经过充分随访，有或无既往非肺癌诊断的患者在2年时（12%对10%）或5年时（16%对15%）发生后续癌症的累积概率无明显差异。第1组患者的1年和5年生存率显著低于第2组患者（分别为59%对48%和29%对17%；P = 0.008）。虽然多变量分析表明分期、烟草相关肿瘤病史和确定性手术切除史是预测长期生存的重要决定因素，但既往恶性肿瘤并非后续恶性肿瘤发生的独立危险因素。
有既往原发性恶性肿瘤的肺癌患者发生后续恶性肿瘤的风险非常高，但与无既往恶性肿瘤的患者所面临的风险无明显差异。
