As reported in the Journal of Clinical Oncology by Thomas E. Stinchcombe, MD, and colleagues, an analysis from the phase III Cancer and Leukemia Group B 140503/Alliance trial has shown high rates of second primary lung cancers with both sublobar and lobar resections for T1aN0 non–small cell lung cancer (NSCLC).
Thomas E. Stinchcombe, MD
Study Details
In the trial, 697 patients with stage T1aN0 NSCLC (using the TNM staging system 7th edition) were randomly assigned between June 2007 and March 2017 to undergo lobar (n = 357) vs sublobar (n = 340) resection. The trial showed noninferiority in disease-free survival for sublobar vs lobar resection. After surgery, patients underwent protocol-defined annual computed tomography surveillance for 5 years.
Key Findings
Median follow-up was 7 years. The rates of second primary lung cancer per patient per year were 3.4% (95% confidence interval [CI] = 2.9%–4.1%) in the total study population, 3.8% (95% CI = 2.9%–4.9%) in the sublobar group (hazard ratio = 1.25, 95% CI = 0.86–1.82, vs lobar group), and 3.1% (95% CI = 2.4%–4.1%) in the lobar group. The estimated 5-year cumulative incidence of second primary lung cancer was 15.9% (95% CI = 12.9%–18.9%) in the total population, 17.2% (95% CI = 12.7%–21.5%) in the sublobar group, and 14.7% (95% CI = 10.6%–18.7%) in the lobar group.
The investigators concluded: “The rate of second primary lung cancers observed is clinically significant and raises questions about the optimal frequency, duration, and type of surveillance imaging.”
Dr. Stinchcombe, of the Division of Medical Oncology, Duke Cancer Institute, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
