Incidence of Second Primaries and Recurrent Disease in Early-stage Lung Cancer: what can we expect in a nodule-care center cohort?

Introduction – Currently, in early-stage lung cancer, often multiple nodules are present upon presentation, or a second lung lesion develops during follow-up. The nature of this lesion has profound impact on therapeutic options. We set out to assess the need of repeated (minimally invasive) diagnosis and treatment procedures by determining the incidence of second primary lung cancer (SPLC) and recurrence in our navigation bronchoscopy (NB) program for incidental pulmonary lesions. Methods – We retrospectively reviewed reports of patients referred for NB and diagnosed with early-stage lung cancer between December 2017 and May 2021. Classification of synchronous, metachronous SPLC, or recurrent disease were based on molecular analysis or pathology-based MDT decisions. Results – In our population of patients referred for NB, 188 patients were diagnosed as (early-stage) lung cancer. Twenty-four percent had a history of lung cancer upon referral for NB. In total, in 40.4% of the patients a new lung lesion that required additional diagnosis and treatment was found. These could be classified as metachronous SPLC in 26% and recurrence in 19%. In newly diagnosed patients, 22% developed SPLC or recurrent disease during a median follow-up time of only 3.3 years (range, 0.5-5.8 years). Conclusion – Our findings demonstrate that in a patient cohort undergoing NB for peripheral pulmonary nodules, 40.4% had SPLC or recurrent disease. Most of these patients had metachronous SPLC, underlining the need to obtain adequate tissue that allows for molecular analysis. In newly diagnosed lung cancer patients 22% needed new procedures which impacts the need for health care facilities.