Abstract
Introduction
The development of a second primary malignancy in a patient with a preexisting diagnosis
of metastatic cancer may be easily overlooked or misattributed to progression of disease.
We report 3 patients with clear-cell renal cell carcinoma (RCC) metastatic to the
lungs who were subsequently diagnosed with non–small-cell lung cancer (NSCLC). We
examined the frequency of this occurrence within our institution and report on the
radiographic findings that may help distinguish between metastatic RCC and primary
lung cancers.
Methods
Patients who received systemic targeted therapy for metastatic RCC at our institution
between January 2006 and October 2013 were identified, and the proportion and incidence
rate for developing NSCLC with preexisting metastatic RCC were calculated.
Results
Two percent (3/151; 95% confidence interval [CI], 0.68%-5.68%) of patients treated
for metastatic RCC with systemic targeted therapies at our institution were subsequently
diagnosed with NSCLC, increasing to 3.5% (3/85; 95% CI, 1.21%-9.87%) among patients
with known RCC pulmonary metastasis. The incident rate for development of NSCLC in
patients with metastatic RCC was 0.87 per 100 person-years (95% CI, 0.22-2.4).
Conclusion
The subsequent diagnosis of a primary lung cancer in metastatic RCC patients occurred
in 2% of patients at our institution and is underreported in the literature. Primary
NSCLC may be underdiagnosed in patients with metastatic RCC. Both the radiographic
appearance and clinical behavior of a lesion may hold clues that can help distinguish
between a new primary and progression of metastatic disease.
Keywords
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References
Surveillance, Epidemiology, and End Results (SEER) Program Stat Fact Sheet: Kidney and Renal Pelvis Cancer. National Cancer Institute. Available at: http://seer.cancer.gov/statfacts/html/kidrp.html. Accessed: April 14, 2016.
- Nivolumab versus everolimus in advanced renal-cell carcinoma.N Engl J Med. 2015; 373: 1803-1813
- Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma.J Clin Oncol. 1999; 17: 2530-2540
- Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study.J Clin Oncol. 2009; 27: 5794-5799
- Two-sided confidence intervals for the single proportion: comparison of seven methods.Stat Med. 1998; 17: 857-872
Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 3. Available at: www.OpenEpi.com, updated April 2013. Accessed: January 13, 2017.
- Imaging in metastatic renal cell carcinoma.AJR Am J Roentgenol. 2007; 189: 360-370
- Distribution of metastatic sites in renal cell carcinoma: a population-based analysis.Ann Oncol. 2012; 23: 973-980
- Synchronous pulmonary renal cell carcinoma metastases and primary non-small cell lung cancer.J Thorac Oncol. 2010; 5: 140-141
- Kyobu Geka. 2003; 56: 47-50
- Multiple primary malignancies in renal cell carcinoma.J Urol. 1998; 160: 1255-1259
- Multiple primary malignancies in patients with renal cell carcinoma: a national population-based cohort study.BJU Int. 2006; 97: 698-702
- Renal cell carcinoma as first and second primary cancer: etiological clues from the Swedish Family-Cancer Database.J Urol. 2011; 185: 2045-2049
- Appearance of pulmonary metastases on high-resolution CT scans: comparison with histopathologic findings from autopsy specimens.AJR Am J Roentgenol. 1993; 161: 37-43
- Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation.Radiology. 1991; 179: 469-476
- Multidetector CT of solitary pulmonary nodules.Thorac Surg Clin. 2010; 20: 9-23
- Consistency of reporting basic characteristics of lung nodules and masses on computed tomography.Acad Radiol. 2004; 11: 233-237
- Computer-aided detection of pulmonary nodules: a comparative study using the public LIDC/IDRI database.Eur Radiol. 2016; 26: 2139-2147
- Solid pulmonary nodule risk assessment and decision analysis: comparison of four prediction models in 285 cases.Eur Radiol. 2016; 26: 3071-3076
- Cigarette smoking is associated with advanced renal cell carcinoma.J Clin Oncol. 2011; 29: 2027-2031
Article Info
Publication History
Published online: February 06, 2017
Accepted:
January 28,
2017
Received in revised form:
January 24,
2017
Received:
November 22,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
