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Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC.
Lung Cancer 2019; 137:23-30LC

Abstract

OBJECTIVES

Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death.

MATERIALS AND METHODS

The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks.

RESULTS

Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (sdRH 2.79; 95% CI: 1.41-5.52; p = 0.003).

CONCLUSION

This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.

Authors+Show Affiliations

Doubs and Belfort Territory Cancer Registry, Besançon University Hospital, F-25000 Besançon, France; EA3181, University of Bourgogne-Franche-Comté, F-25000, Besançon, France. Electronic address: taylor-lucrece.leroy@laposte.net.INSERM CIC 1431, Besançon University Hospital, F-25000 Besançon, France. Electronic address: elisabeth.monnet@univ-fcomte.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France. Electronic address: stephane.guerzider@hotmail.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France. Electronic address: p1jacoulet@chu-besancon.fr.Department of Radiotherapy, Besançon University Hospital, F-25000, Besançon, France. Electronic address: bdebari@chu-besancon.fr.University Hospital of Strasbourg, Nouvel Hôpital Civil, F-67000, Strasbourg, France; University of Strasbourg, F-67000, Strasbourg, France; INSERM UMR 1260, Regenerative Nanomedicine (RNM), FMTS, F-67000 Strasbourg, France. Electronic address: pierre-emmanuel.falcoz@chru-strasbourg.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France. Electronic address: brun-gainet@wanadoo.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France. Electronic address: j.lahourcade@chi-hautecomte.fr.Department of Respiratory Diseases, Nord Franche-Comté Hospital, F-90400 Trévenans, France. Electronic address: faraj.alfreijat@hnfc.fr.Department of Respiratory Diseases, Nord Franche-Comté Hospital, F-90400 Trévenans, France. Electronic address: halmotlak@chu-besancon.fr.Department of Oncology, Besançon University Hospital, F-25000 Besançon, France; INSERM UMR 1098, University of Bourgogne-Franche-Comté, F-25000 Besançon, France. Electronic address: olivier.adotevi@univ-fcomte.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France. Electronic address: dpernet@chu-besancon.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France. Electronic address: dr.jean-charles.polio@laposte.net.INSERM CIC 1431, Besançon University Hospital, F-25000 Besançon, France; INSERM UMR 1098, University of Bourgogne-Franche-Comté, F-25000 Besançon, France. Electronic address: maxime.desmarets@univ-fcomte.fr.Doubs and Belfort Territory Cancer Registry, Besançon University Hospital, F-25000 Besançon, France; EA3181, University of Bourgogne-Franche-Comté, F-25000, Besançon, France. Electronic address: asworonoff@chu-besancon.fr.Department of Respiratory Diseases, Besançon University Hospital, F-25000, Besançon, France; INSERM UMR 1098, University of Bourgogne-Franche-Comté, F-25000 Besançon, France. Electronic address: virginie.westeel@univ-fcomte.fr.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31521979

Citation

Leroy, Taylor, et al. "Let Us Not Underestimate the Long-term Risk of SPLC After Surgical Resection of NSCLC." Lung Cancer (Amsterdam, Netherlands), vol. 137, 2019, pp. 23-30.
Leroy T, Monnet E, Guerzider S, et al. Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC. Lung Cancer. 2019;137:23-30.
Leroy, T., Monnet, E., Guerzider, S., Jacoulet, P., De Bari, B., Falcoz, P. E., ... Westeel, V. (2019). Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC. Lung Cancer (Amsterdam, Netherlands), 137, pp. 23-30. doi:10.1016/j.lungcan.2019.09.001.
Leroy T, et al. Let Us Not Underestimate the Long-term Risk of SPLC After Surgical Resection of NSCLC. Lung Cancer. 2019 Sep 3;137:23-30. PubMed PMID: 31521979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC. AU - Leroy,Taylor, AU - Monnet,Elisabeth, AU - Guerzider,Stéphane, AU - Jacoulet,Pascale, AU - De Bari,Bernardino, AU - Falcoz,Pierre-Emmanuel, AU - Gainet-Brun,Marie, AU - Lahourcade,Jean, AU - Alfreijat,Faraj, AU - Almotlak,Hamadi, AU - Adotevi,Olivier, AU - Pernet,Didier, AU - Polio,Jean-Charles, AU - Desmarets,Maxime, AU - Woronoff,Anne-Sophie, AU - Westeel,Virginie, Y1 - 2019/09/03/ PY - 2019/06/25/received PY - 2019/08/29/revised PY - 2019/09/02/accepted PY - 2019/9/16/pubmed PY - 2019/9/16/medline PY - 2019/9/16/entrez KW - Follow-up KW - Non-small cell lung cancer KW - Postoperative radiotherapy KW - Second primary lung cancer KW - Surgery SP - 23 EP - 30 JF - Lung cancer (Amsterdam, Netherlands) JO - Lung Cancer VL - 137 N2 - OBJECTIVES: Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death. MATERIALS AND METHODS: The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks. RESULTS: Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (sdRH 2.79; 95% CI: 1.41-5.52; p = 0.003). CONCLUSION: This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC. SN - 1872-8332 UR - https://www.unboundmedicine.com/medline/citation/31521979/Let_us_not_underestimate_the_long-term_risk_of_SPLC_after_surgical_resection_of_NSCLC L2 - https://linkinghub.elsevier.com/retrieve/pii/S0169-5002(19)30634-8 DB - PRIME DP - Unbound Medicine ER -