Nofal Sara, J Ostrin Edwin, Zhang Jianjun, Wu Jia, Scheet Paul, Antonoff Mara B, V Heymach John, Toumazis Iakovos
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Cancer. 2025 Sep 1;157(5):941-953. doi: 10.1002/ijc.35452. Epub 2025 Apr 18.
Personal history of cancer is an independent risk factor for developing lung cancer. However, it is not considered in the current US lung cancer screening (LCS) guidelines. In this study, we assessed the risk of developing lung cancer among cancer survivors across 24 different sites of first primary cancer stratified by their LCS eligibility status. Using data from the Patient History Database at the University of Texas MD Anderson Cancer Center, we calculated and compared the cumulative incidence of second primary lung cancer, the overall and the LCS eligibility status-specific, stratified by the site of first primary cancer among cancer survivors. We found that among lung, head and neck (H&N), bladder, cervical, breast, and prostate cancer survivors, the risks of second primary lung cancer were statistically significantly higher compared to the overall risk among all cancer survivors (i.e., all cancer sites combined). Risk ratios (RR) ranged between 1.14 (95%CI:1.00-1.28, p = 0.0431) among prostate cancer survivors to 2.9 (95%CI:2.58-3.26, p < 0.001) among H&N cancer survivors. Other than first primary lung cancer (RR: 1.33; 95%CI:1.14-1.57; p < 0.001), H&N (RR: 1.73; 95%CI:1.45-2.05; p < 0.001) and bladder (RR: 1.32; 95%CI:1-1.74; p = 0.0483) cancer survivors, who were non-eligible for LCS, had significantly higher lung cancer risk than all cancer survivors. In conclusion, H&N, bladder, cervical, breast, and prostate cancer survivors have a high risk of developing second primary lung cancer. Specifically, personal history of H&N and bladder cancer, even among non-eligible for LCS individuals, remain at a sufficiently high risk, which warrants further consideration as an independent eligibility factor for LCS guidelines.
癌症个人史是患肺癌的一个独立危险因素。然而，美国现行的肺癌筛查（LCS）指南中并未考虑这一因素。在本研究中，我们评估了24个不同首发原发性癌部位的癌症幸存者中患肺癌的风险，并根据他们的LCS资格状态进行分层。利用德克萨斯大学MD安德森癌症中心患者病史数据库的数据，我们计算并比较了癌症幸存者中第二原发性肺癌的累积发病率，以及按首发原发性癌部位分层的总体和特定LCS资格状态下的累积发病率。我们发现，在肺癌、头颈部（H&N）、膀胱、宫颈、乳腺和前列腺癌幸存者中，第二原发性肺癌的风险在统计学上显著高于所有癌症幸存者的总体风险（即所有癌症部位合并）。风险比（RR）范围从前列腺癌幸存者中的1.14（95%CI：1.00 - 1.28，p = 0.0431）到H&N癌幸存者中的2.9（95%CI：2.58 - 3.26，p < 0.001）。除了首发原发性肺癌（RR：1.33；95%CI：1.14 - 1.57；p < 0.001）、H&N（RR：1.73；95%CI：1.45 - 2.05；p < 0.001）和膀胱（RR：1.32；95%CI：1 - 1.74；p = 0.0483）癌幸存者（他们不符合LCS资格）外，其患肺癌的风险显著高于所有癌症幸存者。总之，H&N、膀胱、宫颈、乳腺和前列腺癌幸存者患第二原发性肺癌的风险很高。具体而言，H&N和膀胱癌的个人史，即使在不符合LCS资格的个体中，仍然处于足够高的风险水平，这值得作为LCS指南的一个独立资格因素进一步考虑。
