Risk model-based management for second primary lung cancer among lung cancer survivors through a validated risk prediction model.

BACKGROUND: Recent therapeutic advances and screening technologies have improved survival among patients with lung cancer, who are now at high risk of developing second primary lung cancer (SPLC). Recently, an SPLC risk-prediction model (called SPLC-RAT) was developed and validated using data from population-based epidemiological cohorts and clinical trials, but real-world validation has been lacking. The predictive performance of SPLC-RAT was evaluated in a hospital-based cohort of lung cancer survivors. METHODS: The authors analyzed data from 8448 ever-smoking patients diagnosed with initial primary lung cancer (IPLC) in 1997-2006 at Mayo Clinic, with each patient followed for SPLC through 2018. The predictive performance of SPLC-RAT and further explored the potential of improving SPLC detection through risk model-based surveillance using SPLC-RAT versus existing clinical surveillance guidelines. RESULTS: Of 8448 IPLC patients, 483 (5.7%) developed SPLC over 26,470 person-years. The application of SPLC-RAT showed high discrimination area under the receiver operating characteristics curve: 0.81). When the cohort was stratified by a 10-year risk threshold of ≥5.6% (i.e., 80th percentile from the SPLC-RAT development cohort), the observed SPLC incidence was significantly elevated in the high-risk versus low-risk subgroup (13.1% vs. 1.1%, p < 1 × 10-6 ). The risk-based surveillance through SPLC-RAT (≥5.6% threshold) outperformed the National Comprehensive Cancer Network guidelines with higher sensitivity (86.4% vs. 79.4%) and specificity (38.9% vs. 30.4%) and required 20% fewer computed tomography follow-ups needed to detect one SPLC (162 vs. 202). CONCLUSION: In a large, hospital-based cohort, the authors validated the predictive performance of SPLC-RAT in identifying high-risk survivors of SPLC and showed its potential to improve SPLC detection through risk-based surveillance. PLAIN LANGUAGE SUMMARY: Lung cancer survivors have a high risk of developing second primary lung cancer (SPLC). However, no evidence-based guidelines for SPLC surveillance are available for lung cancer survivors. Recently, an SPLC risk-prediction model was developed and validated using data from population-based epidemiological cohorts and clinical trials, but real-world validation has been lacking. Using a large, real-world cohort of lung cancer survivors, we showed the high predictive accuracy and risk-stratification ability of the SPLC risk-prediction model. Furthermore, we demonstrated the potential to enhance efficiency in detecting SPLC using risk model-based surveillance strategies compared to the existing consensus-based clinical guidelines, including the National Comprehensive Cancer Network.

Is voluntary vitamin and mineral supplementation associated with better outcome in non-small cell lung cancer patients? Results from the Mayo Clinic lung cancer cohort.

BACKGROUND: Some previous studies report that 80% of cancer patients take multivitamin and/or mineral supplements. To our knowledge, the consequences of such self-directed supplementation have not been examined previously in non-small cell lung cancer (NSCLC) patients. The goal of this study was to determine whether vitamin/mineral supplementation is associated with improved survival and quality of life in a cohort of NSCLC patients. METHODS: NSCLC patients or their proxies who responded to a questionnaire on vitamin/mineral use were assessed for survival and quality of life. RESULTS: A total of 1129 patients or their proxies responded to a vitamin/mineral questionnaire. Seven hundred and fourteen were vitamin/mineral users of either multivitamins or other specific vitamin/mineral supplements, and the rest non-users. Median survival was 4.3 years versus 2.0 years for vitamin/mineral users and non-users, respectively. A Cox proportional hazards model showed a relative risk of death of 0.74 (95% confidence interval (CI): 0.44, 0.65) (p < 0.01) in favor of vitamin/mineral use after adjustment for multiple prognostic factors, including tumor stage. The Lung Cancer Symptom Scale (LCSS) showed better quality of life among vitamin/mineral users (mean difference in score of 3 (95% CI: 0.8, 5.1) (p < 0.01); and after adjusting for related variables, there remained a trend in favor of vitamin/mineral use mean difference 1.8 (95% CI: 0.2, 3.9) (p = 0.08). CONCLUSIONS: Vitamin/mineral supplementation is associated with better survival and quality of life in this cohort of NSCLC patients. Future prospective clinical trials should focus on the role of such supplements in patients with NSCLC.

Exploring vitamin and mineral supplementation and purported clinical effects in patients with small cell lung cancer: results from the Mayo Clinic lung cancer cohort.

Previous laboratory and pilot clinical trial data suggest that vitamin and/or mineral supplementation may prevent tumor growth in small cell lung cancer. However, rates of supplementation and their major purported clinical effects have never before been studied in patients with small cell lung cancer. This study was undertaken to explore associations between vitamin/mineral supplementation and survival and quality of life within a cohort of small cell lung cancer patients. This study focused on a small cell lung cancer patient cohort from a tertiary care medical center. Small cell lung cancer patients who responded to a follow-up questionnaire on vitamin/mineral use were included. Associations between vitamin/mineral use and both survival and quality of life (Lung Cancer Symptom Scale) were assessed. A total of 178 patients or their proxies responded to one or more vitamin/mineral questionnaires. One hundred seven (60%) were vitamin/mineral users of either multivitamins or other more specific vitamin/mineral supplements, and the rest were nonusers. Two different survival analyses were performed. In the first, median survival was 1.8 vs. 1.3 yr for vitamin/mineral users and nonusers, respectively. The relative risk of death was 0.63 (95% confidence interval [CI]: 0.43, 0.92; P = 0.02) in favor of vitamin/mineral use. After adjustment for multiple prognostic factors, including tumor stage, the relative risk for death was 0.65 (95% CI: 0.43, 1.00; P = 0.05). The second analysis was based on an alternative definition of vitamin/mineral use and showed only a trend to suggest an association between vitamin/mineral use and improved survival (P = 0.09). There were no significant improvements in quality of life in any of the analyses. Vitamin/mineral supplementation is common within this cohort of small cell lung cancer patients. These data suggest an association between vitamin/mineral supplementation and improved survival and point to a need for future studies on vitamin and mineral supplementation in small cell lung cancer patients.