Secondary primary lung cancer after esophageal cancer: a population-based study of 44,172 patients

Abstract

Background

The present study aimed to assess the survival, incidence, and characteristics of secondary primary lung cancer (SPLC) after esophageal cancer (EC-LC).

Methods

The patients with esophageal cancer (EC) who developed SPLC and patients with first primary lung cancer (LC-1) were retrospectively reviewed in the Surveillance, Epidemiology, and End Results 18 registries covering 2000–2016. Overall survival and characteristics were compared between patients with EC-LC and patients with LC-1. The independent relation between a history of EC and death was evaluated by calculating hazard ratios in multivariate Cox regression analysis propensity score-matching analysis, and multiple imputation for cases with missing information.

Results

In comparison with the general population, the patients with EC had a higher risk for developing secondary primary lung cancer (SIR =1.86, 95% confidence interval (CI): 1.69–2.05). A history of EC was found to be an independent risk factor of death for lung squamous carcinoma (LUSC) and lung adenocarcinoma (LUAD) patients in localized stage based on multivariate Cox regression analysis, propensity score-matching analysis and multiple imputation.

Conclusions

There is a significantly increased risk of secondary primary lung cancer in EC survivors and a history of EC adversely affects overall survival in individuals who subsequently develop localized LUSC and LUAD. Clinicians should moderately strengthen lung tissue protection during the management of EC patients.

Keywords:

• Esophageal cancer
• lung cancer
• secondary primary malignancy
• overall survival
• population-based study
• multiple imputation

Acknowledgments

The authors want to thank one of Yadong Gao's best friends Shuai Xia, a software engineer for Baidu, for his assistance in data processing. Yadong Gao want to express his gratitude to Alan Tam and Leslie Cheung, two representative figures of the popular music circles in Hong Kong, whose music have given him powerful emotional support over the past years.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Ethics approval and consent to participate: Affiliated Hospital 2 of Nantong University institutional review board exempted this study from review because it uses deidentified publicly available data.

Additional information

Funding

This work was supported by Science and Technology Support Program of Nantong [Grant MS32015031], Scientific Research Foundation of Nantong Health Committee (Grant MB2019004], Nantong Municipal science and technology planning project [MSZ19037], Special Project of Clinical Medicine of Nantong University [Grants 2019JY002 and 2019JQ006], the ‘Top Six Types of Talents’ Financial Assistance of Jiangsu Province Grant [Grant 2019-WSW-199] and Nantong City Science and Technology Project in Jiangsu Province [Grant JC2021179].