J Cancer 2020; 11(16):4709-4715. doi:10.7150/jca.44581 This issue

Research Paper

Life-long follow-up of second primary lung and extra-pulmonary cancer in lung cancer patients is needed

Bingqing Ma1#, Guoyou Qin1#, Yue Zhang1, Chang Su2✉, Zhenyu Wu1✉

1. Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China.
2. National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, China.
#These authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Ma B, Qin G, Zhang Y, Su C, Wu Z. Life-long follow-up of second primary lung and extra-pulmonary cancer in lung cancer patients is needed. J Cancer 2020; 11(16):4709-4715. doi:10.7150/jca.44581. Available from https://www.jcancer.org/v11p4709.htm

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Background: Lung cancer (LC) patients are at high risk of developing second primary cancer (SPC). This study aimed to explore the risk factors associated with SPC and provide an individualized risk prediction model for LC patients.

Methods: Initial primary lung cancer (IPLC) patients diagnosed between 1998 and 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. A Fine-Gray multivariate competing-risk model was used to estimate the risk of SPC, and the model was assessed regarding discrimination and calibration. A nomogram was designed for clinical convenience to predict the 3-, 5-, and 10- year probabilities of developing SPCs.

Results: A total of 142,491 IPLC patients were considered in this study and 14,374(10.01%) developed SPC within a maximum study period of approximately 19 years. Seven independent prognostic factors were identified according to the competing-risk model, and the SEER summary stage and surgery were the strongest predictors. The model was well calibrated and had good discrimination ability(C-index = 0.746).

Conclusions: LC survivors had an increased risk of SPC and factors associated with good prognosis often predicted SPC. Consideration should be given to increasing the duration of routine follow-up even after 10 years of initial diagnosis for those at the highest risk and site-specific follow-up strategy is also required.

Keywords: lung cancer, second primary cancer, competing risk, nomogram, follow-up