Huang Guanghua, Wang Zhile, Gao Jianhang, Wang Zhaojian, Li Shanqing
Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Beijing, 100730, China.
Gen Thorac Cardiovasc Surg. 2022 May;70(5):463-471. doi: 10.1007/s11748-021-01759-2. Epub 2022 Feb 3.
Our study aimed to reveal the prognostic factors of second primary lung cancer and explore the optimal surgical procedure for Stage II/IIIA second primary lung cancer patients with prior non-small cell lung cancer.
Patients with Stage II/IIIA second primary lung cancer were collected from the Surveillance, Epidemiology and End Results database from 2004 to 2016. Lasso regression, along with univariate and multivariate Cox regression, was used to screen prognostic factors. The propensity score matching was used to minimize baseline differences, and restricted mean survival time was used to compare overall survival and cancer-specific survival of different groups.
A total of 579 patients were enrolled in the study. After data was screened by lasso regression and univariate Cox regression, multivariate Cox regression revealed that age, sex, race, tumor size of initial primary lung cancer, tumor size, histological grade, T stage, N stage and surgical procedure of second primary lung cancer were independent prognostic factors. Further analysis showed that surgery, especially lobectomy, provided better survival in Stage II/IIIA second primary lung cancer.
Our study identified nine independent prognostic factors of Stage II/IIIA second primary lung cancer. Surgery can provide a better prognosis, and lobectomy might be the optimal surgical procedure for these patients.
本研究旨在揭示第二原发性肺癌的预后因素，并探讨既往患有非小细胞肺癌的II/IIIA期第二原发性肺癌患者的最佳手术方式。
从2004年至2016年的监测、流行病学和最终结果数据库中收集II/IIIA期第二原发性肺癌患者。采用套索回归分析以及单因素和多因素Cox回归分析来筛选预后因素。使用倾向评分匹配法以尽量减少基线差异，并采用受限平均生存时间来比较不同组的总生存和癌症特异性生存情况。
本研究共纳入579例患者。经套索回归分析和单因素Cox回归分析筛选数据后，多因素Cox回归分析显示，年龄、性别、种族、初始原发性肺癌的肿瘤大小、第二原发性肺癌的肿瘤大小、组织学分级、T分期、N分期和手术方式是独立的预后因素。进一步分析表明，手术，尤其是肺叶切除术，可为II/IIIA期第二原发性肺癌患者带来更好的生存预后。
本研究确定了II/IIIA期第二原发性肺癌的9个独立预后因素。手术可提供更好的预后，肺叶切除术可能是这些患者的最佳手术方式。
