Skip to main content

ORIGINAL RESEARCH article

Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1492501
This article is part of the Research Topic Community Series in Reducing Adverse Effects of Cancer Immunotherapy: Volume II View all 17 articles

Impact of chemoradiotherapy for first primary lung cancer on the prognosis and re-chemoradiotherapy sensitivity of second primary lung cancer

Provisionally accepted
Zhe Chen Zhe Chen 1Wang Nan Wang Nan 1Gaoming Wang Gaoming Wang 2Jiangjiang Liu Jiangjiang Liu 1Yu Yao Yu Yao 3Haitao Ma Haitao Ma 1Jing Luo Jing Luo 4Kai Xie Kai Xie 1*
  • 1 Department of Cardiothoracic Surgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, Liaoning Province, China
  • 2 Department of Thoracic Surgery, Xuzhou Central Hospital, Xuzhou, Jiangsu Province, China
  • 3 Department of Respiratory Medicine, Nanjing Second Hospital, Nanjing 210000, China., Nanjing, Liaoning Province, China
  • 4 Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China., Nanjing, Liaoning Province, China

The final, formatted version of the article will be published soon.

    Background: Despite undergoing surgery and chemoradiotherapy, patients with first primary lung cancer (FPLC) remain at risk for second primary lung cancer (SPLC), which is associated with a poor prognosis. The effects of FPLC chemoradiotherapy on SPLC prognosis and its sensitivity to rechemoradiotherapy have not been adequately investigated.Methods: This cohort study analyzed data from 23,827 patients who underwent FPLC surgery during 1973-2021, drawn from the Surveillance, Epidemiology, and End Results database. Among these, 5,302 FPLC patients developed SPLC within 5 years of their initial diagnosis. We employed the Fine-Gray competitive risk model, Cox proportional hazards model, and restricted mean survival time analysis to assess the effects of FPLC radiotherapy and chemotherapy on SPLC risk and survival differences.The competitive risk model indicated that FPLC radiotherapy and chemotherapy did not significantly change the risk of developing SPLC. However, the Cox proportional hazards model revealed that FPLC radiotherapy was associated with decreased overall survival (OS; HR=1.251, P<0.001) and cancer-specific survival (CSS; HR=1.228, P=0.001) in patients with SPLC. Conversely, FPLC chemotherapy was linked to improved OS (HR=0.881, P=0.012) in this population. Patients with SPLC who received combined chemoradiotherapy for FPLC exhibited significantly reduced survival times (OS: HR=1.157, P=0.030; CSS: HR=1.198, P=0.018), a finding confirmed across multiple models. For SPLC patients with prior FPLC chemoradiotherapy, subsequent SPLC radiotherapy significantly improved prognosis. Notably, this benefit is even more pronounced in patients who have not received prior chemoradiotherapy. While SPLC chemotherapy enhanced OS for patients who did not receive FPLC chemotherapy, it was associated with reduced CSS for those who had.Conclusions: Overall, FPLC chemoradiotherapy influences SPLC prognosis and influences sensitivity to treatment. Tailoring SPLC management to FPLC treatment regimens may improve survival outcomes.

    Keywords: Radiotherapy1, Chemotherapy2, second primary lung cancer3, prognosis4 radiotherapy1, Prognosis4

    Received: 07 Sep 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Chen, Nan, Wang, Liu, Yao, Ma, Luo and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kai Xie, Department of Cardiothoracic Surgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, Liaoning Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.