Clinical and Translational Oncology

, Volume 21, Issue 3, pp 348–354 | Cite as

Lung cancer patients with a previous extra-pulmonary malignancy should not be considered homogeneous: a clinicopathological analysis of 3530 surgical cases

  • X.-L. Hu
  • S.-T. Xu
  • X.-C. Wang
  • D.-N. Hou
  • C. Bao
  • D. YangEmail author
  • Y.-L. Song
Research Article



Lung cancer patients with a previous extra-pulmonary malignancy have been widely discussed for their postoperative prognosis. Still, whether different types of previous extra-pulmonary malignancy confer different clinicopathological features and outcomes of lung cancer patients deserves further investigation.


The medical records of patients undergoing operation for pulmonary malignancy were retrospectively reviewed. After identifying primary lung cancer out of pulmonary metastasis in patients with a history of previous extra-pulmonary malignancy, clinicopathological parameters and postoperative prognosis were compared between lung cancer patients without and with different types of previous extra-pulmonary malignancy.


Approximately, 5.0% lung cancer patients undergoing surgery had a previous extra-pulmonary malignancy. Prior breast cancer (20%) and colorectal cancer (16%) formed the majority of these previous extra-pulmonary malignancies. Many clinicopathological features such as reason for visit, tumor size and histological subtype were significantly different between lung cancer patients without and with different types of previous extra-pulmonary malignancy (P < 0.05). Lung cancer patients with a previous occurrence of breast cancer were the most different type from patients without a previous extra-pulmonary malignancy in clinicopathological features (P < 0.05). The postoperative overall survival was not significantly different between lung cancer patients without and with different types of previous extra-pulmonary malignancy (P > 0.05).


Previous extra-pulmonary malignancy was confirmed to be harmless to postoperative prognosis of lung cancer patients. Lung cancer patients with a previous extra-pulmonary malignancy, especially with a previous occurrence of breast cancer, were highly heterogeneous in clinicopathological features. These findings implied there might be a unique etiology existing in lung cancer following a previous occurrence of breast cancer.


Lung cancer Extra-pulmonary malignancy Surgery Clinicopathological feature 



This work was supported by State’s Key Project of Research and Development Plan (2017YFC1310602, 2017YFC1310600), Shanghai Municipal Commission of Health and Family Planning (201540078).

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–32.CrossRefGoogle Scholar
  2. 2.
    Chen W, Zheng R, Zeng H, et al. Epidemiology of lung cancer in China. Thorac Cancer. 2015;6(2):209–15.CrossRefGoogle Scholar
  3. 3.
    Li F, Zhong WZ, Niu FY, et al. Multiple primary malignancies involving lung cancer. BMC Cancer. 2015;15:696.CrossRefGoogle Scholar
  4. 4.
    Wu GX, Nelson RA, Kim JY, et al. Non-small cell lung cancer as a second primary among patients with previous malignancy: who is at risk? Clin Lung Cancer. 2017;18(5):543–50.CrossRefGoogle Scholar
  5. 5.
    Halpenny DF, Cunningham JD, Long NM, et al. Patients with a previous history of malignancy undergoing lung cancer screening: clinical characteristics and radiologic findings. J Thorac Oncol. 2016;11(9):1447–52.CrossRefGoogle Scholar
  6. 6.
    Hofmann HS, Neef H, Schmidt P. Primary lung cancer and extrapulmonary malignancy. Eur J Cardiothorac Surg. 2007;32(4):653–8.CrossRefGoogle Scholar
  7. 7.
    Shan S, She J, Xue ZQ, et al. Clinical characteristics and survival of lung cancer patients associated with multiple primary malignancies. PLoS One. 2017;12(9):e0185485.CrossRefGoogle Scholar
  8. 8.
    Pagès PB, Mordant P, Grand B, et al. History of multiple previous malignancies should not be a contraindication to the surgical resection of lung cancer. Ann Thorac Surg. 2013;95(3):1000–5.CrossRefGoogle Scholar
  9. 9.
    Reinmuth N, Stumpf P, Stumpf A, et al. Characteristics of lung cancer after a previous malignancy. Respir Med. 2014;108(6):910–7.CrossRefGoogle Scholar
  10. 10.
    Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Hoboken: Wiley; 2009.Google Scholar
  11. 11.
    Nakadate A, Nakadate M, Sato Y, et al. Predictors of primary lung cancer in a solitary pulmonary lesion after a previous malignancy. Gen Thorac Cardiovasc Surg. 2017;65(12):698–704.CrossRefGoogle Scholar
  12. 12.
    Mery CM, Pappas AN, Bueno R, et al. Relationship between a history of antecedent cancer and the probability of malignancy for a solitary pulmonary nodule. Chest. 2004;125(6):2175–81.CrossRefGoogle Scholar
  13. 13.
    Jin K, Wang K, Zhang H, et al. Solitary pulmonary lesion in patients with history of malignancy: primary lung cancer or metastatic cancer? Ann Surg Oncol. 2018;25:1237.CrossRefGoogle Scholar
  14. 14.
    Gerber DE, Laccetti AL, Xuan L, et al. Impact of prior cancer on eligibility for lung cancer clinical trials. J Natl Cancer Inst. 2014;106(11):dju302.CrossRefGoogle Scholar
  15. 15.
    Laccetti AL, Pruitt SL, Xuan L, et al. Effect of prior cancer on outcomes in advanced lung cancer: implications for clinical trial eligibility and accrual. J Natl Cancer Inst. 2015;107(4):S56.CrossRefGoogle Scholar
  16. 16.
    Laccetti AL, Pruitt SL, Xuan L, et al. Prior cancer does not adversely affect survival in locally advanced lung cancer: a national SEER-medicare analysis. Lung Cancer. 2016;98:106.CrossRefGoogle Scholar
  17. 17.
    Pruitt SL, Laccetti AL, Xuan L, et al. Revisiting a longstanding clinical trial exclusion criterion: impact of prior cancer in early-stage lung cancer. Br J Cancer. 2017;116(6):717–25.CrossRefGoogle Scholar
  18. 18.
    Hattori A, Suzuki K, Aokage K, et al. Prognosis of lung cancer patients with a past history of colorectal cancer. Jpn J Clin Oncol. 2014;44(11):1088–95.CrossRefGoogle Scholar
  19. 19.
    Pagès PB, Mordant P, Cazes A, et al. Prognosis of lung cancer resection in patients with previous extra-respiratory solid malignancies. Eur J Cardiothorac Surg. 2013;44(3):534–8.CrossRefGoogle Scholar
  20. 20.
    Quadrelli S, Lyons G, Colt H, et al. Lung cancer as a second primary malignancy: increasing prevalence and its influence on survival. Ann Surg Oncol. 2009;16(4):1033–8.CrossRefGoogle Scholar
  21. 21.
    Schonfeld SJ, Curtis RE, Anderson WF, et al. The risk of a second primary lung cancer after a first invasive breast cancer according to estrogen receptor status. Cancer Causes Control. 2012;23(10):1721–8.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Department of Pulmonary MedicineZhongshan Hospital, Fudan UniversityShanghaiChina
  2. 2.Department of Thoracic SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina

Personalised recommendations