Zhang Chenxi, Tang Xiyang, Liu Wenhao, Zheng Kaifu, Li Xiaofei, Ma Nan, Zhao Jinbo
Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University. No.569, Xinsi Road, Xi'an, Shaanxi, 710038, China.
Department of Cardio-thoracic Surgery, 900 Hospital of PLA, Fuzhou, Fujian, 350001, China.
Heliyon. 2023 Jul 8;9(7):e17898. doi: 10.1016/j.heliyon.2023.e17898. eCollection 2023 Jul.
Reduced cancer deaths have led to an increase in the number of cancer survivors and the risk of the second primary tumor. This study explored the surgical outcomes of patients with non-small cell lung cancer as the second primary tumor and the impact of previous extra-pulmonary malignancies. Patients' data were obtained from Surveillance, Epidemiology and End Results database. The patients were divided into lung surgery and non-surgery groups. Propensity-score matching was used to balance potential confounders. Kaplan-Meier curves were generated to test the overall survival and lung-cancer-specific survival. Cox regression analysis was performed to calculate death risk. In total 3054 lung surgery and 1094 non-surgery patients with stage I-II non-small cell lung cancer as the second primary tumor were included. The surgery group showed longer overall survival (68 vs. 22 months) and lung cancer-specific survival (not reached vs. 37 months) than those of non-surgery groups (both P < 0.001). Patients with previous hormone-dependent malignancies had similar survival rates (overall survival: 22 vs. 20 months, P = 0.666; lung cancer-specific survival: 38 vs. 37 months, P = 0.292) as those with non-hormone dependent malignancies in the non-surgery group. Significantly longer overall survival (90 vs. 60 months, P = 0.001) was observed in patients with hormone-dependent malignancies in the surgery group; however, there was no difference in lung cancer-specific survival (P = 0.225). Competing risk analysis showed that for patients undergoing lung surgery, there was higher previous malignancy-induced mortality in patients with non-hormone dependent malignancies than in patients with hormone-dependent malignancies. However, there was no difference in lung cancer-induced mortality between the two groups. Patients who underwent lobectomy showed longer survival than those who underwent pneumonectomy and other resection types (89, 27.5 and 65 months, P < 0.001). In summary, lung surgery is beneficial for patients with stage I-II non-small cell lung cancer as the second primary tumor after hormone-dependent malignancy resection.
癌症死亡人数的减少导致了癌症幸存者数量的增加以及患第二原发性肿瘤的风险。本研究探讨了以非小细胞肺癌作为第二原发性肿瘤患者的手术结果以及既往肺外恶性肿瘤的影响。患者数据来自监测、流行病学和最终结果数据库。患者被分为肺手术组和非手术组。采用倾向得分匹配法来平衡潜在的混杂因素。生成Kaplan-Meier曲线以检验总生存期和肺癌特异性生存期。进行Cox回归分析以计算死亡风险。总共纳入了3054例接受肺手术的患者和1094例未接受手术的患者，他们均以I-II期非小细胞肺癌作为第二原发性肿瘤。手术组的总生存期（68个月对22个月）和肺癌特异性生存期（未达到对37个月）均长于非手术组（P均<0.001）。在非手术组中，既往患有激素依赖性恶性肿瘤的患者与非激素依赖性恶性肿瘤患者的生存率相似（总生存期：22个月对20个月，P = 0.666；肺癌特异性生存期：38个月对37个月，P = 0.292）。手术组中患有激素依赖性恶性肿瘤的患者的总生存期显著更长（90个月对60个月，P = 0.001）；然而，肺癌特异性生存期无差异（P = 0.225）。竞争风险分析表明，对于接受肺手术的患者，非激素依赖性恶性肿瘤患者既往恶性肿瘤导致的死亡率高于激素依赖性恶性肿瘤患者。然而，两组之间肺癌导致的死亡率无差异。接受肺叶切除术的患者的生存期长于接受全肺切除术和其他切除类型的患者（89个月、27.5个月和65个月，P < 0.001）。总之，肺手术对于在切除激素依赖性恶性肿瘤后以I-II期非小细胞肺癌作为第二原发性肿瘤的患者有益。
