Frontiers in Oncology (Feb 2020)

Resection of Early-Stage Second Primary Non-small Cell Lung Cancer After Small Cell Lung Cancer: A Population-Based Study

  • Rusi Zhang,
  • Rusi Zhang,
  • Rusi Zhang,
  • Ling Cai,
  • Ling Cai,
  • Gongming Wang,
  • Gongming Wang,
  • Yingsheng Wen,
  • Yingsheng Wen,
  • Fang Wang,
  • Fang Wang,
  • Ningning Zhou,
  • Ningning Zhou,
  • Xuewen Zhang,
  • Xuewen Zhang,
  • Zirui Huang,
  • Zirui Huang,
  • Xiangyang Yu,
  • Kexing Xi,
  • Longjun Yang,
  • Longjun Yang,
  • Dechang Zhao,
  • Dechang Zhao,
  • Yongbin Lin,
  • Yongbin Lin,
  • Lanjun Zhang,
  • Lanjun Zhang

DOI
https://doi.org/10.3389/fonc.2019.01552
Journal volume & issue
Vol. 9

Abstract

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Introduction: A certain number of small cell lung cancer (SCLC) patients become long-term survivors after treatment, and they are at high risk to develop a second primary malignancy, including non-small cell lung cancer. However, the optimal management of early-stage second primary non-small cell lung cancer (SPLC) after SCLC remains unknown. This study aims to evaluate the survival benefits of surgery in these patients.Methods: Patients with early-stage SPLC after SCLC were identified from the Surveillance, Epidemiology, and End Results database. Patients were balanced with propensity score matching (PSM). Overall survival (OS) and lung cancer-specific survival (CSS) were compared between non-surgery group and surgery group with the Kaplan–Meier method and Cox multivariate regressions.Results: A total of 228 patients with early-stage SPLC after SCLC were identified. Surgery was associated with significantly improved OS and CSS in the multivariate Cox regression analysis (OS, 5-year survival: 41.2 vs. 11.6%, HR: 0.42, 95% CI: 0.31–0.59, P < 0.01; CSS, 5-year survival: 46.8 vs. 24.3%, HR: 0.53, 95% CI: 0.37–0.75, P < 0.01). However, no statistically significant survival difference was found between sublobar resection and lobectomy (OS, 5-year survival: 41.0 vs. 45.3%, P = 0.73; CSS, 5-year survival: 43.5 vs. 54.1%, P = 0.49). After 1:1 PSM, 162 patients were selected for further analysis, and surgery continued to demonstrate superior survival (OS, 5-year survival: 44.2 vs. 7.2%, HR: 0.48, 95% CI: 0.33–0.70, P < 0.01; CSS, 5-year survival: 48.0 vs. 20.6%, HR: 0.44, 95% CI: 0.42–0.97, P = 0.03).Conclusion: The resection of early-stage SPLC after SCLC led to significantly improved OS and CSS and therefore should be considered whenever possible. Nevertheless, further randomized controlled trials are warranted to investigate the safety and effect of surgery in these patients.

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