Let us not underestimate the long-term risk of SPLC after surgical resection of NSCLC.

OBJECTIVES: Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death. MATERIALS AND METHODS: The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks. RESULTS: Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (sdRH 2.79; 95% CI: 1.41-5.52; p = 0.003). CONCLUSION: This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.

High-resolution CT predictors of hypersensitivity pneumonitis.

BACKGROUND: The purpose of this study was to evaluate the use of high-resolution chest computed tomography (HRCT) to distinguish hypersensitivity pneumonitis (HP) from other diffuse parenchymal lung diseases (DPLDs). METHODS: We examined 130 consecutive patients admitted to our hospital with DPLDs proved by HRCT. Patients underwent clinical and paraclinical examinations. Two readers interpreted 111 HRCT scans using predefined criteria. RESULTS: The findings in patients with HP were compared to those with other DPLDs (non-HP) by univariate and multivariate analyses. Five independent radiological predictors were identified and were given a weight according to their regression coefficient: ground-glass attenuation nodules (4 points), homogeneous ground-glass opacity (3 points), patchy ground-glass opacity (2 points), absence of adenopathy (2 points), and absence of linear/reticular patterns (2 points). A total score (that we called "diagnostic index") of 5 offered the best trade-off between sensitivity and specificity. At this point of the ROC curve, the sensitivity, specificity, and likelihood ratio were 74%, 90% and 7.7, respectively. Given a pre-test probability of HP of 34% (i.e., 38 HP / 111 patients), the post-test probability was 79%. CONCLUSION: Our results provide evidence that HRCT can accurately distinguish HP from other DPLDs.