Survival After Second Primary Lung Cancer Following Non-Hodgkin Lymphoma: A U.S. Population-Based Study Open Access

Inagaki, Lina (2013)

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Background: Cancer survivors are known to have a higher risk of developing second primary cancer (SPC). While Hodgkin lymphoma attracts more attention, non-Hodgkin lymphoma (NHL) survivors account for a larger population of those who develop SPC, and lung cancer accounts for the largest risk of SPC among NHL-survivors. Although a follow-up care plan for cancer survivors has been recommended, concrete guidelines for screening for SPC have not been established.
Methods: Study patients were identified from the SEER program from 1990 through 2009. A total of 863 NHL survivors who developed second primary lung cancer and 3,452 patients among 232,202 first primary lung cancer patients without a history of malignancy were randomly sampled and included in the analysis. The overall survival (OS) between the two groups were compared using a Log-rank test, followed by subset analysis for estimated survival among patients with localized stage lung cancer, in which OS was significantly different, using Cox proportional hazard regression, controlling for sex, race, year of diagnosis, age at diagnosis, histology, tumor grade and marital status.
Results: NHL survivors experienced significantly inferior survival after lung cancer compared to patients without a history of malignancy at localized stage disease: 5-year OS was 33.0% vs. 44.8% (p < 0.001), whereas the survival did not differ significantly for regional stage: 13.9% vs. 19.2% (p = 0.38), and distant stage: 0% vs. 2.9% (p = 0.10). The subset analysis for patients with localized stage showed that the adjusted Hazard Ratio for death among NHL survivors was 1.38 (95% CI, 1.10-1.73; p = 0.005).
Conclusion: NHL survivors were shown to have inferior survival when diagnosed with localized stage lung cancer compared to the general population. Because NHL survivors may not benefit from screening, the promotion of lung cancer screening to reduce mortality among NHL survivors warrants careful assessment.

Table of Contents

I. Introduction 1

II. Methods 7

III. Results 15

IV. Discussion 20

V. Future Directions 23

VI. References 24

VII. Tables 28

VIII. Figures 32

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