Elsevier

Lung Cancer

Volume 35, Issue 2, February 2002, Pages 189-194
Lung Cancer

Multiple primary malignancies involving lung cancer—clinical characteristics and prognosis

https://doi.org/10.1016/S0169-5002(01)00408-1Get rights and content

Abstract

The incidence of multiple primary malignancies has increased in recent decades. The present study attempts to determine the clinical characteristics, the smoking factor, prognosis and temporal relationship of lung cancer to other cancers in patients with multiple primary malignancies. A total of 193 patients with multiple primary cancers involving lung cancer were found among 22,405 cancer cases diagnosed in Taipei Veterans General Hospital, between 1993 and 1997. Patients’ clinical characteristics, smoking habit, tumor location, lung cancer histology, staging and survival were recorded and analyzed. The results showed that smoking is a significant risk factor for the development of multiple primary malignancies involving lung cancer (P<0.001). Of the 193 patients in this study, 51 had lung cancer diagnosed before the occurrence of other primary cancers (lung cancer first group, LCF group) and the remaining 142 patients had another cancer site develop ahead of the lung cancer (other cancer first group, OCF group). There was a significant difference between the time of the diagnosis of the first primary cancer to that of the second primary cancer in the LCF group and in the OCF group (median 10 vs. 46 months, P<0.001). For lung cancer staging, 53.3% of LCF patients suffered from stage I–II lung cancer, while 24.5% of OCF patients suffered from stage I–II lung cancer. Upper aerodigestive tract tumors were the most frequent tumors accompanying lung cancer, followed by colorectal and cervical cancer. Patients with cervical cancer were at a higher risk of developing lung cancer. Median survival was 65 months in the LCF patients and 81 months in the OCF patients, when calculated from the diagnosis of the first cancer (P=0.558). Median survival was 36 and 14 months, respectively, when calculated from the diagnosis of the second cancer (P=0.081). Median survival (37 vs. 14 months, P=0.085) and 3-year survival (62.5 vs. 25.4%, P=0.002), calculated from the diagnosis of the second primary lung cancer, was better in those LCF patients who developed another primary lung cancer than in the OCF patients who developed a second primary lung cancer. In conclusion, smoking is a risk factor for the development of multiple primary cancers. Upper aerodigestive tract cancer, colorectal cancer and cervical cancer were the tumors most frequently accompanying lung cancer. The staging status and median survival of patients who had a second primary lung cancer were better than in the general lung cancer population. Careful follow-up and intensive treatment is suggested for these patients.

Introduction

Multiple primary malignancies are defined as malignant neoplasms that occur apart from the first cancer [1]. Observations of multiple primary cancers were previously considered isolated and exceptional cases. However, as a result of the improvement in diagnostic tools, treatment modalities and supportive care, survival time for cancer patients has been prolonged and the number of multiple primary cancers has continued to grow [1], [2]. This increase in the diagnostic rate of multiple primary cancers may be because patients are surviving long enough to develop another primary cancer, due to the involvement of common or different intrinsic/extrinsic factors or carcinogens, such as genetic defects, hormones, dietary factors, previous therapy and most importantly, smoking [3], [4], [5], [6]. The increase in the number of patients experiencing multiple primary malignancies makes it more important to evaluate the risk of different secondary cancers and to detect them as early as possible.

Multiple primary malignancies have provided much important information about environmental carcinogens and genetic problems. Associations or the higher incidence of occurrence between certain cancers, such as lung cancer with upper aerodigestive tract cancer [1], [5], [7] and colorectal cancer with breast cancer [8], [9], [10], are well established. Because of the high association rate of breast cancer, ovarian cancer and colorectal cancer in female patients, more frequent screening or follow-up of these organs, when one has cancer, has been suggested [11]. Whether or not this condition applies to lung cancer in association with other primary cancers is unknown.

The present study attempts to determine the temporal relationship of lung cancer to other cancers in patients suffering from multiple primary malignancies involving lung cancer. In addition, the clinical characteristics, the smoking factor and the prognosis of these patients are also discussed.

Section snippets

Patients and methods

Taipei Veterans General Hospital is a general teaching hospital in Taiwan with more than 2500 beds. There were a total of 22,405 cancer cases diagnosed in our hospital from the beginning of 1993 to the end of 1997. We retrospectively reviewed and analyzed the chart records and computer files of those patients during this period, with a pathological diagnosis of multiple primary malignant tumors, including at least one primary lung cancer. The criteria for multiple primary malignancy that we

Results

Of 22,405 cancer cases, 193 patients had multiple cancers, with lung cancer as one of the diagnoses. Among all cancer patients, 9300 had a smoking habit and 129 of these 9300 patients had multiple cancers. In contrast, only 64 of the 12,912 non-smokers had multiple cancers. Smoking patients had a significantly higher risk for the development of multiple primary malignancies involving lung cancer (P<0.001).

Of the 193 patients with multiple cancers, 179 (92.8%) had double cancers, 13 (6.7%) had

Discussion

According to our data, smoking patients had a significantly higher risk for the development of multiple primary malignancies involving lung cancer. Tobacco consumption has been associated with multiple primary cancers and we reconfirmed this data [5].

Although there was a significant difference in sex distribution (male to female ratio) in the LCF group and in the OCF group (Table 1), no significant difference was found if we excluded those cancers which occur only in female or male patients,

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