P-206
LUNG CANCER INCIDENTALLY DISCOVERED IN PREVIOUS EXTRAPULMONARY MALIGNANCIES: WHICH IS THE BEST SURGICAL TREATMENT?

Objectives: Lung nodules in patients with previous extrapulmonary cancer are usually approached as metastasis treated with atypical resection, but sometimes they result primitive lung cancers. The purpose of our study is to analyze predictive factors for overall survival (OS) in this group of patients.

Methods: Data of 83 patients with a previous primary extrapulmonary tumour underwent lung operation between January 2004 and December 2013 for suspicious metastatic nodules revealed primary lung cancer were reviewed. The lung operation was performed if the patients met the following criteria: (a) controlled previous neoplasm; (b) completely resectable pulmonary nodules; (c) general condition and pulmonary function to tolerate lung resection. Surgery was performed in three ways: atypical resection, atypical resection with intraoperatory histology and lobectomy, atypical resection and staged lobectomy after definitive histological exam.

Results: Surgery was lobectomy in 55 (66%) and wedge resection in 28 (34%) patients. In 29 (35%) cases intraoperative histological examination and lobectomy was performed, 31 (37%) patients underwent staged lobectomy. Final pathology showed adenocarcinoma in 55 (66%), squamous carcinoma in 21 (25%), other in seven (9%) cases. Overall two-, five- and 10-year survival rates were 75%, 59% and 29%, respectively. Sixteen (19%) patients died of cancer: 10 (12%) died of lung cancer and six (7%) of previous tumour. Overall survival was strictly associated with lung cancer, with a five-year survival of 11% in patients who died of lung cancer and 79% in patients who died of previous cancer (P < 0.001). Stage of lung cancer and lymphoadenectomy were significantly associated with survival (five-year survival after lobectomy for stage pT<1b vs pT>2a was 81% vs 27%, P = 0.011 and if lymphadenectomy was associated with lobectomy the five-year survival was 72% vs 30% in pT<1b vs pT>2a, P = 0.003). The site of the previous extrapulmonary neoplasm and the interval between previous tumour and surgery for lung cancer were not significantly associated with survival.

Conclusion: In our experience lung cancer appears to be the cause of death in case of previous extrapulmonary malignancies. A radical approach with lobectomy and lymphoadenectomy seems to be the best treatment also in this group of patients, independently from the timing of surgery and lobectomy.

Disclosure: No significant relationships.