Portal de Periódicos da CAPES

PS01.77: Risk-Stratification for Second Primary Lung Cancer

2016; Elsevier BV; Volume: 11; Issue: 11 Linguagem: Inglês

10.1016/j.jtho.2016.09.112

1556-1380

Summer S. Han, Gabriel Rivera, Iona Cheng, Scarlett Lin Gomez, Sylvia K. Plevritis, Heather A. Wakelee,

Multiple and Secondary Primary Cancers

The widespread adoption of computed tomography (CT) screening enables the early detection of lung cancer (LC) and is expected to increase the number of long-term LC survivors. While recent studies show that LC survivors have a high risk of developing second primary lung cancer (SPLC), there are currently no consensus screening guidelines for SPLC. In order to implement effective screening programs for LC survivors, it is important to assess the risk of developing SPLC and evaluate the clinical utility of risk-stratification for SPLC. The Surveillance, Epidemiology, and End Results was used to identify a population-based cohort of 25,521 subjects who: (i) were diagnosed with initial primary lung cancer (IPLC) between 1988 and 2003; and (ii) survived at least 5 years since initial diagnosis. We used a proportional subdistribution hazards model to estimate the absolute risk of developing SPLC among LC survivors in the presence of competing risks. Considered predictors included age, sex, race, treatment, histology, stage, and extent of disease. We conducted decision curve analysis to evaluate the clinical utility of the stratification approach using the prediction model; clinical net benefit was calculated by summing the benefits (true positives) and subtracting the harms (false positives) and weighting these by the threshold probability at which a patient might opt for screening. While the average 10-year risk for SPLC among LC survivors was 7.43%, the estimated risk varied substantially with a range of 0.65% and 12.7% when stratified by age and histology of IPLC. Compared to a reference age group of 70-74, LC survivors with a younger age ( 75) had significantly reduced risks of SPLC with HR of 0.55, 0.56, 0.43, 0.16 for age groups 85, respectively(P < 1x10-3). LC survivors with carcinoma, NOS or carcinoid had significantly reduced risks versus adenocarcinoma(HR=0.55, 0.27, P=1.0x10-4, 4x4-10-10 respectively). The stratification by quintiles of the estimated risk shows that the observed proportion of SPLC cases was significantly higher in the 5th quintile group(6.53%) versus the 1st quintile group(1.69%)(P<10-10). The decision curve analysis yielded a range of risk thresholds(1%-11.5%) at which the clinical net benefit of the risk model-based strategy was larger than those under hypothetical "all-screening" or "no-screening" scenarios. The risk-stratification approach for SPLC can be potentially useful in identifying LC survivors to be screened by CT. More comprehensive environmental and genetic data would help enhance the predictability and stratification of the risk model for SPLC.