Abstract
Background
Patients with non-small cell lung cancer (NSCLC) and a prior or synchronous second malignancy are generally excluded from clinical trials. Therefore, little is known on prevalence and prognosis of these patients.
Methods
1252 patients diagnosed with NSCLC in our center from 2006 to 2017 were studied. Overall survival (OS) of patients with a prior or synchronous malignancy was compared to controls including case–control analysis.
Results
158 patients (12.6%) had a prior malignancy. The most common sites were prostate (17%), breast (16%), gastrointestinal tract (12%), head and neck (11%), bladder (10%), and lung (8%). Compared to controls, patients with prior malignancy were older (71.3 vs. 67.5 years), but had otherwise better prognostic characteristics (stage I–III 63 vs. 53%). Survival was identical compared to controls [hazard ratio (HR) 1.017, CI 0.776–1.333]. A further 3.5% of patients had a synchronous malignancy including 34% prior lung cancer. Patients with a synchronous malignancy had an earlier stage (I–III 84%), and had longer median OS in unselected patients (38.6 vs. 16.2 months, p = 0.021). However, the case–control analysis showed similar OS [hazard ratio (HR) 0.899, CI 0.497–1.621].
Conclusions
Prior or synchronous second malignancies are common at diagnosis of NSCLC. The sites reflect the high proportion of smokers in the population. The earlier stage of NSCLC with a second malignancy might be attributed to chance finding of NSCLC during follow-up. The second malignancy does not affect OS of NSCLC. Therefore, the exclusion of patients with second malignancies from NSCLC trials should be reconsidered.
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Acknowledgements
The authors express thanks to J. Ziegler and D. Siebert for excellent organizational support. We thank the patients and their families for providing information and agreeing to the analysis.
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All procedures performed in this study involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (Landesärztekammer Baden-Württemberg F-2017-004).
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Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.
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Faehling, M., Schwenk, B., Kramberg, S. et al. Second malignancy in non-small cell lung cancer (NSCLC): prevalence and overall survival (OS) in routine clinical practice. J Cancer Res Clin Oncol 144, 2059–2066 (2018). https://doi.org/10.1007/s00432-018-2714-5
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DOI: https://doi.org/10.1007/s00432-018-2714-5