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PubMed1990

Second primary tumors following radiotherapy for childhood cancer.

Among a cohort of 9,279 survivors of childhood neoplasms other than retinoblastoma treated in Britain before 1980, the cumulative risk of a second primary tumor (SPT) by 25 years from 3-year survival was 3.7%. This corresponds to about five times the number expected from rates of cancer occurring in the general population. In the absence of both radiotherapy and chemotherapy, there was four times the expected number of subsequent cancers. The risk of an SPT associated with radiotherapy but not chemotherapy and both radiotherapy and chemotherapy were 6 and 9 times that expected, respectively. There is evidence that radiotherapy was involved in the development of many of the SPT's observed. However, case-control investigations are required to examine the relationship between relative risk of an SPT and therapy in detail. Secondary leukemia appears to occur more frequently among more recently diagnosed children with cancer. It is important to continue to monitor the occurrence of SPT's with a view to identifying the least carcinogenic therapies that are consistent with not compromising survival prospects.

Child↗

PubMed2005

Lesions resembling Langerhans cell histiocytosis in association with other lymphoproliferative disorders: a reactive or neoplastic phenomenon?

Langerhans cell histiocytosis (LCH) has been described in association with a variety of neoplasms preceding, after, or synchronous with the other tumor. In some cases, a neoplasm may arise as a complication of therapy for LCH, and in others, the association may be coincidental. Synchronous occurrence has been reported most commonly in association with malignant lymphoma in which discrete proliferations of Langerhans cells (LCs) histologically indistinguishable from LCH are seen. In most cases, these LCs are closely related to or intermingling with the primary pathology. The nature of LCs in this context remains elusive with debate as to whether they represent a true clonal neoplasm or an exaggerated reactive phenomenon. The lack of evidence for LCH progression or disease elsewhere strongly supports the latter. We have encountered 5 examples of LCH-like proliferations occurring in the context of other lymphoproliferative disorders. These include 2 cases of mycosis fungoides and 1 of cutaneous B-cell pseudolymphoma, associations that to our knowledge have not been described before. Two patients were female, and the clonality of the LC proliferation was assessed using laser capture microdissection and the human androgen receptor. The results showed that the LCs forming discrete nodules in a case of cutaneous B-cell pseudolymphoma and a case of Hodgkin's lymphoma were polyclonal. This suggests that, at least in a proportion of cases, the aggregates of LCs occasionally identified within other lymphoproliferative lesions represent a reactive proliferation rather than a potentially aggressive second neoplasm.

Adult↗

PubMed2004

[Mutagen sensitivity in patients with multiple primary tumors (MPT) of the head and neck region--quantitative and qualitative assessment based on bleomycin assay].

The occurrence of second primary tumors after curative treatment or simultaneous multiple malignancies are current problem in head and neck cancer. The mutagen sensitivity is well known marker to predict patient proneness to develop the second tumor. The frequency and localization of spontaneous and mutagen induced chromatid breaks in peripheral blood lymphocytes (PBLs) in patients with multiple primary tumors (MPT) may help in defining regions involved in cancerogenesis process. The case control study using the bleomycin sensitivity assay (number of chromatid breaks per cell (b/c) was performed in 36 patients with MPT and two control groups: 52 patients with one malignancy and 47 healthy individuals. The differences between examined patients and control groups were estimated using U Mann-Whitney test. The b/c level in PBLs of patients with MPT ranged from 0.26 to 4.12 (mean 1.53) and was significantly higher (p<0.000006) both compared with patients with one malignancy (b/c ranged from 0.02 to 3.08; mean 0.74) and healthy controls (b/c ranged from 0.04 to 1.14; mean 0.41). An increase of b/c index was observed in almost all chromosomal arms. The majority of chromosomal locations with the increased proportion of breaks in the group of patients with multiple tumors were identified as regions where loci involved in DNA repair, cell cycle regulation suppressor genes and oncogenes were found. Statistically higher induced individual susceptibility in MPT patients compared with single tumor and healthy controls was confirmed. Comparable induced mean b/c was found in patients with two smoking-related cancers as well as with not smoking related tumors.

Antibiotics, Antineoplastic↗

PubMed1994

Colonoscopic follow-up of colorectal carcinoma.

PURPOSE: The value of routine colonoscopy in the prevention or early detection of metachronous carcinoma of the colon and rectum remains unproven. This study attempts to clarify this issue. METHODS: An analysis of a personal series of 460 patients with primary colorectal carcinoma treated by the second author between 1972 and 1990 was reviewed. After various exclusions, there remained 231 patients who had been prospectively followed by colonoscopy with a mean follow-up period of 5.6 years. RESULTS: In 48 (21 percent) patients, there were synchronous adenomas present at the time of the initial resection for carcinoma and 35 (73 percent) of these patients subsequently developed metachronous adenomas, being recurrent in 22. Ninety-five (52 percent) of the 183 patients without synchronous adenomas eventually developed metachronous adenomas, so that overall 130 (56 percent) patients developed a metachronous adenomas. Four patients developed a metachronous carcinoma that was either Dukes A or B, and all remain well at the time of final follow-up. These metachronous carcinomas were found after a mean interval of seven and three-quarter years. All four patients had synchronous adenomas and all developed metachronous adenomas on multiple occasions before the metachronous carcinoma was detected. Thus, a subset consisting of only 22 patients produced all four metachronous malignancies--a rate of 18 percent. CONCLUSION: It would appear that the presence of synchronous adenomas with the subsequent development of recurring metachronous adenomas is significant and warrants a more intensive follow-up program to ensure the early diagnosis and more likely cure of any metachronous carcinoma.

Adenoma↗

PubMedDate not supplied

[The diagnosis and surgical treatment of primary malignant liver tumors and metastases].

Results were analyzed of diagnosis and treatment of 314 patients with malignant tumours of the liver. Of these, 36 had primary tumours of the liver (PTL), 278 were presenting with metastatic tumours (MTL). In addition, an analysis was carried out in 1236 oncological patients in order that the frequency of metastasizing of tumours into the liver might be determined together with the specific weight of metastases of different locations. The rates of tumours metastasizing to the liver were found out to be 45.7, 33.3, 30.1 percent with the gallbladder, major duodenal papilla, stomach respectively. Ultrasonography is an effective diagnostic tool for malignant tumours of the liver, being of great informative value (sensitivity in PTL--97.2%, MTL--75.7%). Eight (22.2%) patients with PTL and seventeen (6.1%) ones with MTL underwent surgical treatment. The only radical modality of treatment is still anatomical resection of the liver. Investigations are under way designed to study efficiency of thermo-(cryo) destruction of solitary and single liver metastases if surgical resection is beyond the bounds of possibility.

Biopsy, Needle↗

PubMed1997

Factors affecting smoking cessation in patients with head and neck cancer.

The role of tobacco in the etiology of upper aerodigestive tract carcinomas is well established. Smoking decreases the effectiveness of cancer therapy and increases the risk of all treatment modalities. Smoking adversely affects the general health of the cancer survivor and places the patient at risk of developing additional primary tumors. The smoking habits of head and neck cancer patients were evaluated using a questionnaire administered at two tertiary head and neck cancer centers. Demographic factors, level of exposure, tumor stage and location, treatment modalities, concomitant alcohol use, and cessation methods were examined. Results demonstrate a high rate of smoking cessation at the time of cancer diagnosis. Significant demographic factors were not identified. Physical barriers to continued smoking because of cancer treatment as well as counseling at the time of tumor diagnosis were the most effective deterrents to continued tobacco use. Heavy alcohol use was a negative predictor of smoking cessation. Pharmacologic aids alone were found to be of no value. This study demonstrates the difficulties with smoking cessation in head and neck cancer patients, and emphasizes the importance of intervention by the otolaryngologist-head and neck surgeon.

Adult↗

PubMed2001

Other primary cancers occurring after treatment of superficial oesophageal cancer.

BACKGROUND: Recent advances in endoscopic diagnosis and treatment have led to better prognosis for patients with superficial oesophageal cancer. The incidence of subsequent other primary cancer (SOPC) has become a new problem for patients who survive after treatment of superficial oesophageal cancer. METHODS: Between 1966 and 1998, 368 patients with superficial oesophageal cancer, histologically confirmed as squamous cell carcinoma after resection, were reviewed for the presence of SOPC. RESULTS: Among the 368 patients, 43 developed SOPC. The most frequent sites of SOPC were the stomach (11 patients) and hypopharynx (11). Subsequent cancers of the stomach and hypopharynx developed significantly more frequently in heavy smokers. The 5-year cumulative occurrence rate of subsequent cancers within the fields of endoscopy of the upper gastrointestinal tract (stomach, hypopharynx and residual oesophagus) was 15 per cent. CONCLUSION: Gastric and hypopharyngeal cancers were frequently found after resection of superficial oesophageal cancer. A history of heavy smoking at the time of initial resection may be a risk factor. To make an early diagnosis of subsequent cancers, follow-up observation by upper gastrointestinal endoscopy is important after treatment of oesophageal cancer.

Carcinoma, Squamous Cell↗

PubMed1996

Mammographic appearance of cancer in the opposite breast: comparison with the first cancer.

OBJECTIVE: Patients who have had cancer in one breast are at high risk for cancer in the contralateral breast. These bilateral cancers may be synchronous or metachronous. If the manifestations on mammography were similar in both breasts, an aggressive search for the mammographic findings of the first breast cancer might lead to early detection of the contralateral cancer. The purpose of this study was to evaluate mammograms for patients with bilateral cancers to determine whether the mammographic appearance of the contralateral cancer is likely to be the same as that of the first cancer. MATERIALS AND METHODS: We retrospectively reviewed the pathologic and mammographic records of 69 patients with surgically proven bilateral primary breast cancer. Thirty four of 69 (49%) had synchronous cancer, and 35 (51%) had metachronous cancer. Mammographic appearances were classified as microcalcifications, spiculated mass, nonspiculated mass (whether circumscribed or poorly defined), asymmetric or developing density, architectural distortion, and normal. Multiple findings were subclassified as major and minor findings. All findings were compared between both breast cancers, and statistical significance was determined by the two-sample Z test. RESULTS: Forty six (67%) of 69 patients had different major mammographic findings in the contralateral cancer. Of 30 patients whose first cancers had microcalcifications, 20 (67%) had microcalcifications in the contralateral cancer. Of 39 patients whose first cancers lacked microcalcifications, 17 (44%) had microcalcifications in the contralateral cancer. This difference was statistically significant (p = .02). Of 26 patients whose first cancers had spiculated masses, 9 (35%) had a contralateral spiculated mass. Of 43 patients whose first cancers lacked spiculated masses, 12 (28%) had a contralateral spiculated mass. This difference was not statistically significant (p = .22). CONCLUSION: Our results show that contralateral tumors usually have major mammographic findings different from those of the first cancer, and the mammographic signs of the first cancer do not indicate the most likely appearance of cancer in the contralateral breast. Evaluation of a contralateral mammogram should be performed without regard for the mammographic findings for the first cancer.

Adult↗

PubMed1985

Second malignant neoplasms in children: an update from the Late Effects Study Group.

This paper presents an update from the Late Effects Study Group on 292 cases of second malignant neoplasms (SMN) occurring in individuals who were diagnosed with their first neoplasm in childhood. Data are presented regarding the types of first and second neoplasm, the therapy administered, and the predisposing factors. Of the 292 cases (308 SMN), the most common primary was retinoblastoma followed by Hodgkin's disease, soft-tissue sarcomas, and Wilms' tumor. This is not similar to the relative frequency of these cancers in children but rather reflects specific risk factors. Bone sarcomas were the most common SMN among the 208 SMN developing in previously irradiated sites while acute leukemia was the most common SMN unassociated with radiation. Known predisposing conditions to cancer were present in 73 cases; retinoblastoma was the most common of these, followed by neurofibromatosis. There were ten patients with three and three patients with four malignant neoplasms. In 14 patients, the cause of SMN was not suggested by known risk factors as these patients had negative family histories and received no radiation or chemotherapy. We note, therefore, that although most cases of SMN in survivors of childhood cancer can be attributed to radiation, genetic disease, chemotherapy, or combinations of these, unrecognized predisposition or chance may also play a role.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

[Multiple basal cell carcinomas following radiation therapy for nasopharyngeal cancer].

INTRODUCTION: Basal cell carcinoma (BCC) is a cutaneous, generally primary malignancy, most common among the elderly. We report the case of a patient presenting numerous BCCs several years after radiation therapy for nasopharyngeal cancer and discuss the risk factors for this tumor and the role played by radiation in its genesis. CASE: A 30-year-old woman presented with pigmented facial lesions that had been developing over the past year. Eleven years earlier, she had had an undifferentiated nasopharyngeal carcinoma (T3N2M0), which was treated by neoadjuvant chemotherapy and then external radiation therapy. Initial cutaneous examination noted two lesions that were identified as BCC after biopsy. The tumors were excised surgically. Neither clinical nor radiological check up showed signs of basal cell nevus syndrome. DISCUSSION: BCC is the most frequent malignant tumor. It is observed mainly among those aged 45-60 years. Disorders that might promote or complicate BCC should be systematically sought in young patients, especially basal cell nevus syndrome. While our patient may have had this syndrome, we found none of the other clinical or radiographic elements often observed with it. The occurrence of BCC within the irradiation area, the multiplicity of lesions, and the sufficient latency period are consistent with radiation-induced tumors. We found no reports in the literature of BCC following radiation treatment for nasopharyngeal cancer, but the occurrence of these tumors in our patient suggests the need for close supervision in such cases.

Adult↗

PubMed2003

Radiation-induced laryngeal angiosarcoma after cervical tuberculosis and squamous cell carcinoma: case report and review of the literature.

Primary laryngeal angiosarcoma (LA) is quite rare with only 13 cases reported in English literature to date. A case of LA after radiation therapy for tuberculosis and squamous cell carcinoma is reported. A 70-year-old woman had a history of radiation therapy for left cervical tuberculosis at the age of 28. At 60 years of age a squamous cell carcinoma of the larynx was found and chemotherapy and radiotherapy, consisting of a total dose of 68.4 Gy, were administered. At the age of 68, recurrent squamous cell carcinoma was suspected from several biopsies, and a total laryngectomy with right thyroidectomy was performed. The tumor cells formed vascular spaces and expressed some endothelial markers, such as CD34, CD31, and Ulex europaeus agglutinin I, but no epithelial markers, such as cytokeratins or epithelial membrane antigen. No residual squamous cell carcinoma was found. In the present case, it was suspected that irradiation to the larynx for cervical tuberculosis and squamous cell carcinoma induced angiosarcoma. The patient was still alive despite multiple skin and soft tissue metastasis 3 years and 6 months after the radical operation. Distinction of postirradiation angiosarcoma from pseudoangiosarcomatous carcinoma seems difficult but is important because irradiation is not effective and an initial radical surgery is the only effective treatment. Although irradiation is a common treatment for laryngeal squamous cell carcinoma, this is only the second case of radiation-induced LA in English literature.

Aged↗

PubMed2001

Multiple oral squamous epithelial lesions: are they genetically related?

The development of second primary tumors (SPTs) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. Currently, clinical and histologic parameters are used to determine whether or not SPT is present. Recent studies suggest that many SPTs in the upper aerodigestive tract have a common clonal origin, challenging the longstanding multiclonal origin concept. To determine genetic relationships among multiple oral cancerous and precancerous lesions (MOCP), we analysed 100 lesions from 26 Japanese patients. Lesion development was synchronous and metachronous. We looked for patterns of microsatellite alterations (MA) using seven markers at chromosomes 3p14, 9p21, and 17p13, where MA occurs early in oral carcinogenesis. Loss of heterozygosity (LOH) was found in 52.6% (41/78), 62.5% (60/96), and 59.3% (32/54) of informative MOCP at 3p14, 9p21, and 17p13, respectively. Microsatellite instability (MI) was observed in 11, 26 and 13% of the samples at 3p14, 9p21, and 17p13 markers, respectively. Patterns of MA were concordant in only nine (14%) of 63 lesions from four (18%) of 22 patients who initially presented with noninvasive lesions. However, two of four patients with invasive cancer as indexed lesion showed 16 (43%) clonally related MOCP among 37 lesions (P=0.003). The results suggest that the majority of MOCP arise from clonally independent cells affected by field cancerization. However, the probability of mucosal spread of clonal malignant or premalignant cells may increase along with malignant progression.

Carcinoma, Squamous Cell↗

PubMed2005

Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract.

OBJECTIVES: To determine the independent risk factors for intravesical tumor recurrence in patients with primary transitional cell carcinoma of the upper urinary tract, and to develop a risk-stratification model to allow more accurate prediction of recurrence risk. METHODS: Of 141 patients who underwent total nephroureterectomy for clinically localized transitional cell carcinoma of the upper urinary tract, the data from 89 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer and/or a follow-up period of less than 1 year were excluded from this study. Multivariate analysis by Cox's proportional hazards model was used to determine independent risk factors for intravesical tumor recurrence. RESULTS: Of 89 patients, 37 (41.6%) experienced subsequent intravesical tumor recurrence during a median follow-up period of 39.7 months (range 12.0 to 186.6). On multivariate analysis, tumor multiplicity, pathologic stage, tumor size, and surgical modality had a statistically significant impact on the risk of intravesical tumor recurrence (P = 0.0075, P = 0.0221, P = 0.0377, and P = 0.0413, respectively). Pathologic stage and tumor size were inversely correlated to the risk. A scoring system for the risk of intravesical recurrence was developed from the proposed prognostic factors, and the patients were stratified into three groups according to their scores, with statistically significant prognostic differences between them (P = 0.0018). CONCLUSIONS: Tumor multiplicity, pathologic stage, tumor size, and surgical modality all had a significant impact on the incidence of intravesical tumor recurrence. A risk stratification model constructed from tumor biologic factors may be useful in the follow-up of patients with transitional cell carcinoma of the upper urinary tract.

Aged↗

PubMed2000

Simultaneous treatment of multiple primary cancers of the oral cavity and other sites.

Multiple primary cancers are not uncommon in the head and neck region. Since the time for treatment will be prolonged if each lesion is treated separately, simultaneous treatment of the cancers is preferred to ensure complete remission of lesions and increased survival of patients. In this paper, the efficacy of combined treatment was evaluated in 9 patients with oral cancers and concurrent cancers in other sites. The mean age of the patients was 54 years (range 44 to 66). The tongue (8) and mandible (1) were the sites of involvement. Concurrent cancers were found most often in the esophagus, followed by stomach and lung. Histologically, 7 lesions were diagnosed as squamous cell carcinomas. All oral cancers were treated by surgery. Neck dissection and simultaneous reconstruction were performed in 5 patients. In addition, concurrent cancers were treated simultaneously by endoscopic mucosal resection in 2 patients and radical resection followed by immediate reconstruction in 6 other patients. However, simultaneous surgical treatment of all lesions could not be performed in an individual with 3 cancers. The time of surgery ranged from 23 minutes to 17 hours and 30 minutes. With the exception of 2 patients who died of postoperative complications and had needed treatment for dysphasia, all patients were discharged after 1 to 2 months. Four of the patients are still alive 2 years and 6 months after surgery. These results indicate that simultaneous treatment is effective in selected cases of multiple cancers.

Adenocarcinoma↗

PubMedDate not supplied

Primary gynecological neoplasms and clinical outcomes in patients diagnosed with breast carcinoma.

The purpose of this study was to quantify and describe nonmammary neoplasms (n-MN), particularly gynecological neoplasms, in a patient population previously diagnosed with breast cancer. Data were collected prospectively in our institutional review board-approved registry for patients diagnosed with infiltrating breast cancer or ductal carcinoma in situ. Patients who developed a second, n-MN were identified; neoplastic site, time to development after breast cancer, and clinical outcomes were recorded. FIGO stage was recorded for patients who developed a gynecological neoplasm. Synchronous bilateral breast cancer was defined as a second, contralateral diagnosis made within 12 months of the first and, similarly, synchronous n-MN were defined as those identified within 1 year of a breast cancer diagnosis. Outcome curves were generated using the method of Kaplan and Meier, and compared using the log-rank test. Of 4126 patients diagnosed with breast cancer, 3% developed a n-MN, the majority of which were nongynecological and asynchronous to the initial breast cancer diagnosis. Three percent of patients diagnosed with breast cancer were diagnosed with a second, n-MN. Among patients who developed a n-MN, most developed a nongynecological cancer more than 1 year after the initial breast cancer diagnosis, and their outcomes were significantly worse than those patients who did not develop a n-MN.

Adult↗

PubMed1990

The molecular genetics of meningiomas.

There are many findings which suggest that an individual may inherit a predisposition for developing a meningioma. The cytogenetics of meningiomas has been well known for some time with monosomy of chromosome 22 as the most characteristic finding. We have confirmed the cytogenetic findings in cultured cells, using molecular genetic techniques on primary tumour tissue. The only difference found between the results of the two techniques was the greater proportion of terminal deletions of the long arm of chromosome 22 detected by the molecular method. The minimal deletion common to 81 meningiomas, and thus the position of the tentative meningioma tumour suppressor gene (TSG), has been determined to lie distal to the myoglobin locus on the long arm of chromosome 22, corresponding to the region 22q12.3-qter. All common histological types of meningioma show the same genetic abnormalities. Study of one tumour with areas of both meningothelial and anaplastic meningioma demonstrated the tumour to be clonal and a partial deletion of 22q to have occurred prior to the development of anaplasia. In order to map in more detail the position of, and finally identify, the TSG involved, a new series of 195 chromosome 22 genomic DNA fragments have been cloned. Current evidence suggests that the genes involved in neurofibromatosis type 2 and meningioma are located at different points on the long arm of chromosome 22 and thus are separate entities.

Base Sequence↗

PubMedDate not supplied

An investigation of primary malignancies associated with ampullary carcinoma.

BACKGROUND/AIMS: As ampullary carcinoma has a favorable prognosis, associated malignancies have potential prognostic significance in these patients. This study focused on the incidence and characteristics of preexisting, coexisting and subsequent malignancies in patients with ampullary carcinoma. METHODOLOGY: Sixty-four cases of ampullary carcinoma were retrospectively identified. Fifty-four patients underwent surgical resection, while in the other ten, histological diagnosis was reached after biopsy and/or autopsy. Other primary malignancies associated with ampullary carcinoma, occurring in the prediagnostic or postdiagnostic period, were investigated. The mean postdiagnostic follow-up period was 3.9 years (range, 0-23 years). RESULTS: Other malignancies occurred in 17 patients (27%), being found before (n=9), at (n=7), or after (n=5) diagnosis of ampullary carcinoma. The total number of associated lesions was 23, including one case of quadruple and four cases of triple carcinoma. The major associated malignancies were colonic carcinoma (n=9), gastric carcinoma (n=5), and uterine carcinoma (n=3). Twenty-one lesions were treated surgically or endoscopically. One patient died from synchronous extrahepatic bile duct carcinoma and one from leukemia, and one died from subsequent urinary bladder carcinoma. Development of other malignancies was related to age but not to gender, family history, adjuvant chemo/radiotherapy, or tumor pathology. CONCLUSIONS: Ampullary carcinoma is associated with a high incidence of other malignancies, particularly colonic and gastric carcinomas. The possibility of associated malignancies should therefore be considered in preoperative screening and postoperative follow-up of patients with ampullary carcinoma.

Aged↗

PubMed1999

Factors influencing ten-year survival in resected stages I to IIIa non-small cell lung cancer.

OBJECTIVE: The purpose of this study was to determine (in survivors of 5 years after resection of their lung cancer) whether age, sex, histologic condition, and age have any influence on furthering survival beyond 5 years. METHODS: From 1973 to 1989, 686 patients were alive and well 5 years after complete resection of their lung cancers. Survival analysis was carried out with only deaths from lung cancer treated as deaths. Deaths from other causes were treated as withdrawals. Multivariate Cox regression was used to test the relationship of survival to age, sex, histologic condition, and stage. RESULTS: The population in this study had the following characteristics at the time of operation: The male/female ratio was 1.38:1, and the median age was 61 years. The histologic condition of their lung cancer was adenocarcinoma in 412 patients, squamous cell in 244 patients, large cell carcinoma in 29 patients, and small cell carcinoma in 1 patient. The stage of the disease was stage IA in 263 patients, IB in 261 patients, IIA in 12 patients, IIB in 68 patients, and IIIA in 82 patients. The extent of resection was a lobectomy or bilobectomy in 579 patients, pneumonectomy in 55 patients, and wedge resection or segmentectomy in 52 patients. A recurrence or a new lung primary occurrence was considered as failure to remain free of lung cancer. The median follow-up on all patients was 122 months from initial treatment. Of the 686 patients, 26 patients experienced the development of late recurrence and 36 new cancers, beyond 5 years. Overall survival for 5 additional years after a 5-year check point was 92.4%. Likewise, survival by nodal status was 93% for N0 tumors, 95% for N1 tumors, and 90% for N2 tumors. Survival by stage was 93% for stage I tumors and 91% for stage II or IIIA tumors. CONCLUSIONS: In patients with surgically treated lung cancer, neither age, sex, histologic condition, nor stage is a predictor of the risk of late recurrence or new lung cancer. The only prognostic factor appears to be the survival of the patient free of lung cancer for 5 years from the initial treatment, with a resultant favorable outlook to remain well for 10 or more years.

Adenocarcinoma↗