title: Second primary lung cancers: smokers versus nonsmokers after resection of stage I lung adenocarcinoma.
abstract: BACKGROUND
  Smokers have a higher risk of developing non-small cell lung cancer (NSCLC) than never-smokers, but the relative risk of developing second primary lung cancer (SPLC) is unclear. Determining the risk of SPLC in smokers versus never-smokers after treatment of an initial cancer may help guide recommendations for long-term surveillance.
  
  
  METHODS
  Patients who underwent resection for stage I adenocarcinoma were identified from a prospectively maintained institutional database. Patients with other histologies, synchronous lesions, or who received neoadjuvant or adjuvant therapy were excluded. The SPLCs were identified based on Martini criteria.
  
  
  RESULTS
  From 1995 to 2012, a total of 2,151 patients underwent resection for stage I adenocarcinoma (308 never-smokers [14%] and 1,843 ever-smokers [86%]). SPLC developed in 30 never-smokers (9.9%) and 145 ever-smokers (7.8%). The SPLC was detected by surveillance computed tomography scan in the majority of patients (161; 92%). In total, 87% of never-smokers and 83% of ever-smokers had stage I SPLC. There was no significant difference in the cumulative incidence of SPLC between never-smokers and ever-smokers (p = 0.18) in a competing-risks analysis. The cumulative incidence at 10 years was 20.3% for never-smokers and 18.2% for ever-smokers.
  
  
  CONCLUSIONS
  Although smokers have a greater risk of NSCLC, the risk of a second primary cancer developing after resection of stage I lung cancer is comparable between smokers and never-smokers. The majority of these second primary cancers are detectable at a curable stage. Ongoing postoperative surveillance should be recommended for all patients regardless of smoking status.
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Robert R
authors.initials: RR
authors.lastname: McMillan
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Camelia S
authors.initials: CS
authors.lastname: Sima
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Saad M
authors.initials: SM
authors.lastname: Hasan
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Ahmad
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Feiran
authors.initials: F
authors.lastname: Lou
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
authors.affiliation: Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: huangj@mskcc.org.
authors.forename: James
authors.initials: J
authors.lastname: Huang
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*