Wu Bingqun, Cui Yong, Tian Jintao, Song Xiaoping, Hu Pengcheng, Wei Shenhai
Department of Thoracic Surgery, First Hospital of Tsinghua University, Beijing 100016, China.
Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
J Thorac Dis. 2019 Feb;11(2):573-582. doi: 10.21037/jtd.2018.11.96.
Second primary cancer (SPC) is not a rare event for patients with non-small cell lung cancer (NSCLC), especially for those who survive for a longer period of time. This study was aimed to explore the effects of SPC on the survival of NSLCL patients.
A total of 241,805 patients with primary NSCLC were identified between 2004 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) database. The incidence of SPC and its effect on the overall survival (OS) and lung cancer-specific survival (LCSS) was explored and analyzed using Cox regression model with SPC being treated as a time-dependent covariate.
The incidence of SPCs after the diagnosis of NSCLC was 6.4%, with the second primary lung cancer being the most common one (45.1%). About half of the SPCs (50.7%) occurred during the first year after the diagnosis of NSCLC. It seemed that patients who developed SPC late in the follow-up period tended to have poor prognosis. Multivariable analysis with Cox regression showed that the occurrence of SPC was a poor prognostic factor for patients with NSCLC [hazard ratio (HR), 1.298; 95% confidence interval (CI), 1.270-1.326; P=0.000], and it increased the risk of LCSS (versus no SPC, HR, 1.094; 95% CI, 1.066-1.123; P=0.000).
The occurrence of SPC after the diagnosis of NSCLC was not a rare event, and it indicated a poorer prognosis compared with patients without it. During the follow-up, attention should be paid to the screening of SPC especially the second primary lung cancer, and a rational surveillance policy should be formed and implemented.
对于非小细胞肺癌（NSCLC）患者而言，第二原发性癌症（SPC）并非罕见事件，尤其是对于那些存活时间较长的患者。本研究旨在探讨SPC对NSLCL患者生存的影响。
2004年至2014年间，从监测、流行病学和最终结果（SEER）数据库中识别出总共241,805例原发性NSCLC患者。将SPC作为时间依赖性协变量，使用Cox回归模型探讨并分析SPC的发生率及其对总生存期（OS）和肺癌特异性生存期（LCSS）的影响。
NSCLC诊断后SPC的发生率为6.4%，其中第二原发性肺癌最为常见（45.1%）。约一半的SPC（50.7%）发生在NSCLC诊断后的第一年。似乎在随访后期发生SPC的患者预后往往较差。Cox回归多变量分析显示，SPC的发生是NSCLC患者的不良预后因素[风险比（HR），1.298；95%置信区间（CI），1.270 - 1.326；P = 0.000]（此处原文有误，按照正确英文为P = 0.000），并且它增加了LCSS的风险（与无SPC相比，HR，1.094；95% CI，1.066 - 1.123；P = 0.000）。
NSCLC诊断后SPC的发生并非罕见事件，与未发生SPC的患者相比，其预后较差。在随访期间，应注意SPC尤其是第二原发性肺癌的筛查，并应制定和实施合理的监测策略。
