Prior Extrapulmonary Malignancy and Outcomes After Lung Cancer Resection.
With the aging population, thoracic surgeons increasingly encounter patients with primary lung cancer who have a history of prior extrapulmonary malignancy (PEM). We investigated whether PEM independently compromises survival after curative-intent lung cancer resection and whether any difference is explained by impaired cancer control or competing mortality.
We retrospectively analyzed 1,857 consecutive lung cancer resections performed in 2017-2018 at 12 Yokohama City University-affiliated institutions. After exclusion of 74 patients with prior lung cancer only, 1,783 patients remained: 505 in the PEM group and 1,278 in the no prior extrapulmonary malignancy (NPEM) group. Overall survival (OS), recurrence-free survival (RFS), inverse probability of treatment weighting (IPTW)-adjusted outcomes, and Fine-Gray competing-risk analyses were evaluated.
Compared with the NPEM group, the PEM group was older and included higher proportions of men, ever-smokers, patients diagnosed during surveillance for other diseases, and patients treated with limited resection. Unadjusted 5-year OS was 80.43% in the PEM group and 81.42% in the NPEM group (p=0.092), whereas 5-year RFS was 68.76% and 68.52%, respectively (p=0.983). PEM was not independently associated with OS [hazard ratio (HR)=1.046, 95% confidence interval (CI)=0.825-1.326, p=0.712] or RFS (HR=0.970, 95%CI=0.798-1.178, p=0.756). IPTW-adjusted analyses were concordant. Fine-Gray models showed no significant association between PEM and lung cancer-related death or non-lung-cancer death.
PEM did not independently worsen postoperative cancer control or survival after lung cancer resection. Curative-intent surgery should therefore be considered according to the biology and operability of the current lung cancer rather than prior cancer history alone.
We retrospectively analyzed 1,857 consecutive lung cancer resections performed in 2017-2018 at 12 Yokohama City University-affiliated institutions. After exclusion of 74 patients with prior lung cancer only, 1,783 patients remained: 505 in the PEM group and 1,278 in the no prior extrapulmonary malignancy (NPEM) group. Overall survival (OS), recurrence-free survival (RFS), inverse probability of treatment weighting (IPTW)-adjusted outcomes, and Fine-Gray competing-risk analyses were evaluated.
Compared with the NPEM group, the PEM group was older and included higher proportions of men, ever-smokers, patients diagnosed during surveillance for other diseases, and patients treated with limited resection. Unadjusted 5-year OS was 80.43% in the PEM group and 81.42% in the NPEM group (p=0.092), whereas 5-year RFS was 68.76% and 68.52%, respectively (p=0.983). PEM was not independently associated with OS [hazard ratio (HR)=1.046, 95% confidence interval (CI)=0.825-1.326, p=0.712] or RFS (HR=0.970, 95%CI=0.798-1.178, p=0.756). IPTW-adjusted analyses were concordant. Fine-Gray models showed no significant association between PEM and lung cancer-related death or non-lung-cancer death.
PEM did not independently worsen postoperative cancer control or survival after lung cancer resection. Curative-intent surgery should therefore be considered according to the biology and operability of the current lung cancer rather than prior cancer history alone.
Authors
Ishikawa Ishikawa, Shigeta Shigeta, Nemoto Nemoto, Yasuura Yasuura, Aoyama Aoyama, Toyoda Toyoda, Kaburaki Kaburaki, Isaka Isaka, Kikuchi Kikuchi, Kameda Kameda, Yamanaka Yamanaka, Noma Noma, Gorai Gorai, Mishina Mishina, Ando Ando, Iitsuka Iitsuka, Kikunishi Kikunishi, Koga Koga, Adachi Adachi, Woo Woo
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