Impact of prior malignancy on non-small cell lung cancer presentation, management, and survival.

Background: As survival after an initial cancer diagnosis improves, an increasing number of patients are diagnosed with lung cancer after a prior malignancy. These patients represent a clinically distinct population, yet population-level data describing lung cancer presentation, treatment patterns, and outcomes in this group remain limited. Methods: We performed a retrospective cohort study using the National Cancer Database (NCDB), including adults diagnosed with non-small cell lung cancer (NSCLC) between 2010 and 2021. Patients whose lung cancer represented their first malignancy were compared with those diagnosed with lung cancer after a prior malignancy of any type. Outcomes of interest included tumor size and stage at diagnosis, treatment strategy, and overall survival (OS). Results: Among 1,304,953 patients with NSCLC, 266,458 (20.4%) had a history of prior malignancy. Compared with patients with first-primary NSCLC, those with prior malignancy were older at diagnosis and more frequently presented with smaller tumors (≤3 cm: 57.2% Conclusions: Patients diagnosed with lung cancer after a prior malignancy present with earlier-stage disease and are more frequently managed with parenchyma-sparing surgical approaches, yet experience worse adjusted OS. These findings highlight meaningful differences in presentation and management in a growing population of cancer survivors.