title: History of multiple previous malignancies should not be a contraindication to the surgical resection of lung cancer.
abstract: BACKGROUND
  Patients with a history of previous malignancy are often encountered in a discussion of surgical resection of non-small-cell lung cancer (NSCLC). The outcome of patients with 2 or more previous cancers remains unknown.
  
  
  METHODS
  We performed a retrospective study including all patients undergoing resection for NSCLC from January 1980 to December 2009 at 2 French centers. We then compared the survival of patients without a history of another cancer (group 1), those with a history of a single malignancy (group 2), and those with a history of 2 or more previous malignancies (group 3).
  
  
  RESULTS
  There were 5,846 patients: 4,603 (78%) in group 1, 1,147 (20%) in group 2, and 96 (2%) in group 3. The proportion of patients included in group 3 increased from 0.3% to 3% over 3 decades. Compared with groups 1 and 2, group 3 was associated with older age, a larger proportion of women, earlier tumor stage, less induction therapy, and fewer pneumonectomies. Despite this, postoperative complications and mortality were similar in groups 2 and 3, and higher than in group 1. Five-year survival rates were 44.6%, 35.1%, and 23.6% in groups 1, 2, and 3, respectively (p < 0.000001 for comparison between 3 groups; p = 0.18 for comparison between groups 2 and 3). In multivariate analysis, male sex, higher T stage, higher N stage, incomplete resection, and study group were significant predictors of adverse prognosis.
  
  
  CONCLUSIONS
  Despite earlier diagnosis and acceptable long-term survival, patients operated on for NSCLC after 2 or 3 previous malignancies carried a worse prognosis than did those undergoing operation after 1 malignancy or if there was no previous diagnosis of cancer.
authors: Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors: Pierre-Benoit
authors: PB
authors: Pagès
authors: Pierre
authors: P
authors: Mordant
authors: Bertrand
authors: B
authors: Grand
authors: Alain
authors: A
authors: Badia
authors: Christophe
authors: C
authors: Foucault
authors: Antoine
authors: A
authors: Dujon
authors: Françoise
authors: F
authors: Le Pimpec-Barthes
authors: Marc
authors: M
authors: Riquet
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies