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OBJECTIVES: The goal of this study was to investigate whether an operation can offer survival benefits for patients with a second primary non-small-cell lung cancer (NSCLC) after a lobectomy for a first primary NSCLC and to analyse the characteristics affecting the survival of those patients. METHODS: We performed survival analyses of patients with a second primary NSCLC based on the Surveillance, Epidemiology and End Results program and used propensity score matching to reduce the potential bias and analyse the data. In addition, the primary observational end point was overall survival (OS), and the secondary observational end point was histologic migration. RESULTS: The data from 944 patients were used to perform the main analysis. A total of 36.2% of patients experienced a shift in tumour histologic type between 2 diagnoses of primary NSCLC, and this shift significantly affected OS (P = 0.0065). The median survival time in patients with surgical resection and those without an operation was 52.0 months versus 33.0 months, respectively. Patients with surgical resection at the secondary diagnosis had better survival than those without surgery (5-year OS rate: 48.0% vs 34.0%, P < 0.001). In addition, compared with a pneumonectomy and a sublobar resection, a lobectomy was the optimal surgical procedure for patients diagnosed with a second primary NSCLC after adjusting for other confounders (adjusted hazard ratio: 0.68, P < 0.01). However, in the subgroup analysis, lobar and sublobar resections could provide similar survival benefits for patients with tumour size ≤20 mm (P = 0.5). CONCLUSIONS: The operation, especially a lobectomy, can prolong OS in patients with a second primary NSCLC. Besides, sublobar resection can be performed in selected patients with tumour size ≤20 mm. Moreover, histologic migration may impact the survival of those patients with a secondary primary NSCLC.
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Background: Lung transplantation is an effective treatment for saving the lives of patients with end-stage lung disease (ESLD). Lung transplant-related morbidity and mortality has significantly higher than other solid organ transplants. Among the pre-transplant variables that affect the survival rate after transplantation, nutritional status are associated with poor survival rate. In order to provide basis for formulating nutritional evaluations for lung transplant recipients in the future, we retrospectively analyzed the nutritional status of lung transplantation recipients and explore its correlation with the short-term prognosis. Methods: This retrospective cohort study included patients who were hospitalized in 2020 and underwent lung transplant surgery at Shanghai Pulmonary Hospital. Inclusion criteria: (I) aged ≥18 years; (II) have been diagnosed with ESLD; (III) have received no other effective treatments; (IV) have undergone a transplantation at Shanghai Pulmonary Hospital. We summarized the patients' general information, including their sex, age, major lung disease etc. And we also collected nutritional status, such as Nutritional Risk Screening 2002 (NRS 2002), subjective global assessment (SGA) and nutritional-related indicators, including albumin, prealbumin, retinol-binding protein etc. before surgery and 1 month after surgery. In addition, we collected postoperative drainage volume, length of stay in intensive care unit (ICU), total hospital days, and hospitalization costs to evaluate the short-term prognosis. Results: A total of 33 lung transplant recipients were included and successfully underwent surgery. Of the patients, 16 had preoperative NRS 2002 scores ≥3 points, of whom 7 were assessed by the SGA as having mild-moderate malnutrition and 9 as having severe malnutrition. The albumin indexes of these 16 patients, including their prealbumin, and calcium contents, were significantly lower than those of patients with NRS scores <3. Patients with preoperative NRS scores ≥3 had higher drainage volumes, longer hospitalization times, and higher total hospitalization costs than those with NRS scores <3. Conclusions: Lung transplant recipients have a higher incidence of nutritional risk and malnutrition, which seriously affects their short-term prognosis. Thus, in clinical practice, lung transplant recipients should be screened for nutritional risk and provided preoperative nutritional support to maintain a good preoperative status to improve their prognosis.
