The prognostic significance of a previous malignancy in operable non-smallcell lung cancer

There is little data in literature on survival of patients with lung cancer as a second primary (SP) malignancy. This retrospective study was undertak en to investigate whether a previous malignancy has prognostic significance in operable non-small cell lung cancer (NSCLC). Sixty-six patients with SP NSCLC were compared with 75 'first primary' (FP) NSCLC patients without a previous malignancy. All the 141 patients had been surgically treated with curative intent at The Netherlands Cancer Institute (NKI) between 1977 and 1996. Patients who had undergone resections for lung metastases were exclud ed. Clinical and pathological characteristics were collected and a multivar iate analysis on all the 141 patients was carried out. All the previous mal ignancies were invasive cancers associated with metastatic potential and pr edominantly located in the aerodigestive tract. Female-male ratio was highe r in the SP group (29 vs. 15%, P= 0.06). Tumour diameter was smaller in the SP group (3.0 vs. 4.7cm, P <0.0001). Pneumonectomy was performed less freq uently in the SP group. Five-year survival rate was higher in the SP group (61 vs. 34%, P= 0.04). Univariate favourable prognostic factors were; small tumour diameter, female gender, favourable pTNM-stage, favourable pT-stage . favourable cTNM-stage, no post-operative radiotherapy and a history of pr evious malignancy. Multivariate analysis showed tumour diameter, female gen der and pTNR I-stage to be the major potential confounders. When adjustment s were made for these three variables, the prognostic advantage of the SP g roup disappeared. It was concluded that SP NSCLC has a similar prognosis wh en compared with FP NSCLC. NSCLC diagnosed during the follow-up of a previo us malignancy, and deemed operable, therefore, warrants the same diagnostic and therapeutic approach as NSCLC as first malignancy. (C) 2001 Elsevier S cience Ireland Ltd. All rights reserved.