title: Survival after second primary lung cancer: a population-based study of 187 Hodgkin lymphoma patients.
abstract: BACKGROUND
  Lung cancer accounts for the largest absolute risk of second malignancies among Hodgkin lymphoma (HL) survivors. However, no population-based studies have compared overall survival (OS) between HL survivors who developed nonsmall cell lung cancer (HL-NSCLC) versus patients with first primary NSCLC (NSCLC-1).
  
  
  METHODS
  The authors compared the OS of 178,431 patients who had NSCLC-1 and 187 patients who had HL-NSCLC (among 22,648 HL survivors), accounting for sex, race, sociodemographic status, calendar year, and age at NSCLC diagnosis, and NSCLC histology and stage. All patients were reported to the population-based Surveillance, Epidemiology, and End Results Program. Hazard ratios (HRs) were derived from a Cox proportional hazards model.
  
  
  RESULTS
  Although the NSCLC stage distribution was similar in both groups (20% localized, 30% regional, and 50% distant), HL survivors experienced significantly inferior stage-specific OS. For patients with localized, regional, and distant stage NSCLC, the HRs (95% confidence interval [CI]) for death among HL survivors were 1.60 (95% CI, 1.08-2.37; P < .0001), 1.67 (95% CI, 1.26-2.22; P = .0004), and 1.31 (95% CI, 1.06-1.61; P = .013), respectively. Among HL-NSCLC patients, significant associations were observed between more advanced NSCLC stage and the following variables: younger age at HL diagnosis (P = .003), younger age at NSCLC diagnosis (P = .048), and longer latency between HL and NSCLC diagnoses (P = .015).
  
  
  CONCLUSIONS
  Compared with patients who had de novo NSCLC, HL survivors experienced a significant 30% to 60% decrease in OS after an NSCLC diagnosis. Further research is needed to not only elucidate the clinical-biologic underpinnings of NSCLC after HL, including the influence of previous HL treatment, but also to define the role of lung cancer screening in selected patients.
authors.affiliation: Department of Radiation Oncology and Rubin Center for Cancer Survivorship, University of Rochester School of Medicine, Rochester, New York 14642, USA. michael_milano@urmc.rochester.edu
authors.forename: Michael T
authors.initials: MT
authors.lastname: Milano
authors.forename: Huilin
authors.initials: H
authors.lastname: Li
authors.forename: Louis S
authors.initials: LS
authors.lastname: Constine
authors.forename: Lois B
authors.initials: LB
authors.lastname: Travis
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology