Predictors of Secondary Lung Cancer Among Hodgkin Lymphoma Survivors: A Nationwide Analysis

There is insufficient data regarding the true incidence of secondary lung cancer (SLC) among Hodgkin Lymphoma (HL) survivors and the predisposing factors. Herein we identified 862 patients with SLC out of 56,856 patients with HL with an incidence rate of 157 per 10 0,0 0 0 person-years. In the weighted multivariate model, male gender, older age, and radiation therapy are significant predictors for SLC. Future research that validates our predictors could help establish a model to tailor screening for high-risk patients.Purpose: There is insufficient data regarding the incidence rate of secondary lung cancer among Hodgkin lymphoma (HL) survivors and the predisposing factors. Methods: We analyzed the data from the cohort of patients who had HL between 1973 and 2015 using the Surveillance Epidemiology and End Results database (SEER). Data on patient's age, gender, year of diagnosis with HL, Ann-Arbor stage, Histology, racial groups, date of last follow-up, date of death, and treatment modalities were collected.Results: We identified a total of 56,856 patients with HL; of those, 862 had secondary lung cancer, with an incidence rate of 157 (95%CI: 147-168) per 100,000 person-years. The median overall survival from time of HL diagnosis for those with secondary lung cancer was 12.1 years (95% CI: 10.7-13) compared to 27.1 years (95% CI: 26.5-27.6) for those who did not develop lung cancer (log-rank P-value of symbolscript .01). After propensity score weighting, radiation therapy was associated with a higher risk of secondary lung cancer (hazard ratio (HR): 1.23, 95% CI: 1.002-1.55) with a P-value of 0.048. Older age at the time of HL diagnosis and male gender were associated with higher risk, with an HR of 1.07 (95% CI 1.062-1.073) and an HR of 1.602 (95% CI 1.33-1.94), respectively. Furthermore, chemotherapy increased the risk only among older age groups.Conclusion: Older age at the time of HL diagnosis, male gender, radiation therapy, and chemotherapy only among older age groups were associated with higher risk for secondary lung cancer, with 50% of the cases occurring within 9.1 years following HL diagnosis.

Automated summary

Insufficient data regarding the true incidence of secondary lung cancer (SLC) among Hodgkin Lymphoma (HL) survivors and the predisposing factors. The study identified 862 patients with SLC out of 56,856 patients with HL, with an incidence rate of 157 per 100,000 person-years. Male gender, older age, and radiation therapy were significant predictors for SLC.