Long-term Survival Following Lung Resection for Metachronous Lung Cancer in Patients with Bladder Cancer

Objectives:

Separate primary cancer is defined as an independent new primary malignant tumor arising simultaneously or after the diag­nosis of another neoplasm . We analyzed our results in patients with separate primary bladder and lung cancers. Design: Retrospective data review. Setting: University Hospital.

Patients:

Files of patients who were previously operated on for bladder cancer and subsequently underwent lung cancer resection were identified. Patient characteris­tics, clinical, radiologic presentation, surgical management and sur­vival were recorded. Histologic and immunohistochemical analysis were performed.

Results:

5 patients (4 male) were identified. Four had metachronous (17, 29, 84,162 months) and 1 had synchronous cancer. Superficial bladder cancers were identified in 4 patients . One patient had advanced stage bladder cancer. All were transitional cell carcinomas. All lung lesions were identified on a chest X-ray. 3 pa­tients received neoadjuvant treatment. Pathologic stages were T1 NO (n=1), T2N0 (n=2), T2N1 (n=1) and T3N2 (n=1). Histologic diag­nosis was squamous cell (n=3), large cell (n=1) and adenocarci­noma (n=1 ). Cytokeratin 20 was negative in 4 and thrombomodulin was negative in all patients, suggestive of primary lung cancer. Four patients are alive at 14, 24, 34 and 80 months after lung resection . One patient is alive with lung cancer recurrence and one patient died due to lung cancer at 17 months.

Conclusions:

Treatment strategy of separate primary cancers should rely on clinical, radiologic and patho­logic correlation. Aggressive multimodal treatment leads to a favorable outcome in these patients.