Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu 610041, China.
West China School of Medicine, Sichuan University, Chengdu 610041, China.
Lung Cancer. 2023 Jun;180:107218. doi: 10.1016/j.lungcan.2023.107218. Epub 2023 Apr 26.
We conducted this study to identify the risk for second primary malignancy (SPM), especially for second primary extrapulmonary malignancy (SPEM), in resected stage I lung cancer patients.
Resected stage I lung cancer patients were retrospectively enrolled from the SEER database (2008-2017). Standardized incidence ratio (SIR) was used to evaluate the relative risk of SPM of patients as compared to general population. Competing risk model was utilized to identify the risk factors for SPEM of increased risk (rSPEM). A simplified nomogram based on the factors was developed to stratify patients at different risks of rSPEM.
A total of 14,495 patients were enrolled, and 1779 (12.27%) patients developed SPM during follow-up, of which 896 (50.37%) were SPEM. Enrolled patients had higher risk of SPM than general population (SIR: 1.92, 95% CI: 1.83 - 2.01). The yearly morbidity of SPM was about 3% - 4% over time. The three most frequent SPEM were prostate cancer, breast cancer, and urinary bladder cancer. The competing-risk multivariable analysis showed that increasing age, male, and white race were independent risk factors for rSPEM. The simplified nomogram showed favorable performance in stratifying patients at different risks of rSPEM (P < 0.001).
The risk of SPM in stage I lung cancer patients was high. Risk factors for rSPEM were identified and the corresponding simplified nomogram based on the risk factors could discriminate patients at different risks well. The nomogram might help physicians to make more appropriate screening strategy for the SPEM.
本研究旨在确定接受手术治疗的 I 期肺癌患者发生第二原发性恶性肿瘤（SPM），尤其是第二原发性肺外恶性肿瘤（SPEM）的风险。
我们从 SEER 数据库（2008-2017 年）中回顾性纳入接受手术治疗的 I 期肺癌患者。采用标准化发病比（SIR）评估患者 SPM 的相对风险，与普通人群相比。利用竞争风险模型确定 rSPEM 风险增加的 SPEM 危险因素。根据这些因素开发了一个简化的列线图，以对不同 rSPEM 风险的患者进行分层。
共纳入 14495 例患者，随访期间 1779 例（12.27%）患者发生 SPM，其中 896 例（50.37%）为 SPEM。与普通人群相比，纳入患者 SPM 的风险更高（SIR：1.92，95%CI：1.83-2.01）。随着时间的推移，SPM 的年发病率约为 3%-4%。最常见的三种 SPEM 是前列腺癌、乳腺癌和膀胱癌。竞争风险多变量分析显示，年龄增长、男性和白种人是 rSPEM 的独立危险因素。简化的列线图在对不同 rSPEM 风险的患者进行分层方面表现出良好的性能（P<0.001）。
I 期肺癌患者发生 SPM 的风险较高。确定了 rSPEM 的危险因素，并基于这些危险因素开发了相应的简化列线图，可以很好地区分不同风险的患者。该列线图可能有助于医生为 SPEM 制定更合适的筛查策略。
