Preoperative pulmonary function and nutrition predict survival in lung cancer patients with previous operated malignancies.

[BACKGROUND] Patients who have survived initial cancer and develop primary lung cancer may require advanced treatment strategies due to impaired nutritional status. We aimed to identify prognostic factors in this patient group.

[METHODS] This single-center, retrospective study analyzed patients who underwent complete resection for primary lung cancer between 2010 and 2016. Clinical data, including history of previous operated malignancy, physical status, image findings, clinical and pathological stage, recurrence status, and prognosis were collected and analyzed.

[RESULTS] Of the 528 R0-resected patients, 153 had a history of previous operated malignancy. Compared with those without, this group exhibited smaller lung tumor size (P<0.001) and a higher population of pStage 0-IA3 disease (P<0.001). In patients with pStage 0-IA3, low preoperative percent predicted forced expiratory volume in one second (pre-%FEV1) and preoperative prognostic nutritional index (pre-PNI) were significant predictors for poor overall survival (OS), but not in the group without previous operated malignancy. The receiver operating characteristic (ROC) curve analysis identified threshold of 101.1 for pre-%FEV1 and a 43.1 for pre-PNI. Patients with both values below these thresholds (Group 4) had significantly worse OS (P<0.001) and recurrence-free survival (RFS) compared with the other groups.

[CONCLUSIONS] Although lung cancer was more often detected at an earlier stage in patients with previous operated malignancy, this survival advantage was offset by impaired pulmonary and nutritional status. Pre-%FEV1 and pre-PNI, alone or combination, may be potential predictors of poor outcomes in this patients population. These findings highlight the need for perioperative interventions aimed at optimizing pulmonary function and nutritional status, and warrant further validation in prospective studies.