Doubs and Belfort Territory Cancer Registry, Besançon University Hospital, F-25000 Besançon, France; EA3181, University of Bourgogne-Franche-Comté, F-25000, Besançon, France.
INSERM CIC 1431, Besançon University Hospital, F-25000 Besançon, France.
Lung Cancer. 2019 Nov;137:23-30. doi: 10.1016/j.lungcan.2019.09.001. Epub 2019 Sep 3.
Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death.
The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (RH) was used to investigate factors associated with SPLC risk in the presence of competing risks.
Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (RH 2.79; 95% CI: 1.41-5.52; p = 0.003).
This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.
多项研究报告称，接受非小细胞肺癌（NSCLC）手术的患者有发生第二原发性肺癌（SPLC）的高风险。然而，报道的这种风险估计值差异很大，很少有研究考虑到这些患者由于初始疾病的复发和合并症而处于极高的竞争死亡风险。随着时间的推移，对风险因素的评估对 NSCLC 术后监测策略有重大影响。本研究主要旨在使用考虑死亡竞争风险的统计方法，在长期随访系列中测量 SPLC 的风险。
使用基于法国 Doubs 和 Belfort 癌症登记处（France）诊断的 2002 年至 2015 年间完全切除的 I 期至 III 期 NSCLC 患者的累积发生率，估计累积 SPLC 风险。使用比例亚分布风险模型（RH）在存在竞争风险的情况下研究与 SPLC 风险相关的因素。
在 522 名患者中，腺癌和 I 期或 II 期疾病分别占患者的 52.3%和 75.7%。总体而言，84 名患者发生 SPLC（16.1%）。手术后 10 年的 SPLC 累积风险为 20.2%（95%置信区间 [CI]：15.3-23.2），手术后 14 年的 SPLC 累积风险为 25.2%（CI：19.4-31.3）。多变量分析显示，术后接受胸部放疗的患者 SPLC 风险显著升高（RH 2.79；95%CI：1.41-5.52；p=0.003）。
本研究使用适当的统计方法考虑竞争风险，表明在完全切除 NSCLC 后，SPLC 的累积发生率较高，接受术后胸部放疗的患者风险更高。这些数据支持对接受 NSCLC 手术的患者进行终生随访的必要性，以筛查 SPLC。
