Risk of second primary malignancies after definitive treatment for esophageal cancer: A competing risk analysis.
competing risk analysis
esophageal cancer
second malignancies
Journal
Cancer medicine
ISSN: 2045-7634
Titre abrégé: Cancer Med
Pays: United States
ID NLM: 101595310
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
received:
04
08
2019
revised:
26
09
2019
accepted:
20
10
2019
pubmed:
16
11
2019
medline:
20
1
2021
entrez:
16
11
2019
Statut:
ppublish
Résumé
Esophageal cancer is associated with synchronous or metachronous cancer at other primary sites. However, few studies have evaluated the second malignancies after the treatment of esophageal cancer. The present study aimed to clarify the frequency of and risk factors for the second malignancies after definitive therapy for esophageal cancer. We included patients with esophageal cancer who received definitive therapy between 2000 and 2010. Exclusion criteria were synchronous cancer or a past history of cancer. Standardized incidence rate (SIR) was calculated using age- and sex-specific incidence rates from the cancer registry data. To conduct risk analyses, we used the competing risk regression model, which defined death and the development of second malignancies as competing risks. A total of 758 patients were included, with 131 second malignancies occurring in 106 patients (14%), over a median follow-up of 3.7 years. Cumulative incidences of second malignancies after 3, 5, and 8 years were 4.0%, 7.6%, and 13.8%, respectively. The risk of second malignancy was significantly elevated [SIR = 1.83, 95% confidence interval (CI): 1.50-2.22]. The most common sites of primary tumor were the head and neck (20%), followed by the lung (17%), stomach (16%), colon and rectum (11%), and urinary tract (9%). Risk analyses revealed that age ≥ 65 years [subdistribution hazard ratio (sHR): 1.51, 95% CI: 1.01-2.24, vs age < 65] and clinical stages 0-I (sHR: 2.48, 95% CI: 1.46-4.22, vs stage III and IV) and II (sHR: 2.10, 95% CI: 1.23-3.58, vs stage III and IV) were significantly associated with second malignancies. Compared with the general population, an increased incidence of second malignancies was observed in the patients with esophageal cancer in the present study even after definitive treatment. Careful follow-up is required, especially in patients at a higher risk of second malignancies.
Sections du résumé
BACKGROUND
Esophageal cancer is associated with synchronous or metachronous cancer at other primary sites. However, few studies have evaluated the second malignancies after the treatment of esophageal cancer. The present study aimed to clarify the frequency of and risk factors for the second malignancies after definitive therapy for esophageal cancer.
PATIENTS AND METHODS
We included patients with esophageal cancer who received definitive therapy between 2000 and 2010. Exclusion criteria were synchronous cancer or a past history of cancer. Standardized incidence rate (SIR) was calculated using age- and sex-specific incidence rates from the cancer registry data. To conduct risk analyses, we used the competing risk regression model, which defined death and the development of second malignancies as competing risks.
RESULTS
A total of 758 patients were included, with 131 second malignancies occurring in 106 patients (14%), over a median follow-up of 3.7 years. Cumulative incidences of second malignancies after 3, 5, and 8 years were 4.0%, 7.6%, and 13.8%, respectively. The risk of second malignancy was significantly elevated [SIR = 1.83, 95% confidence interval (CI): 1.50-2.22]. The most common sites of primary tumor were the head and neck (20%), followed by the lung (17%), stomach (16%), colon and rectum (11%), and urinary tract (9%). Risk analyses revealed that age ≥ 65 years [subdistribution hazard ratio (sHR): 1.51, 95% CI: 1.01-2.24, vs age < 65] and clinical stages 0-I (sHR: 2.48, 95% CI: 1.46-4.22, vs stage III and IV) and II (sHR: 2.10, 95% CI: 1.23-3.58, vs stage III and IV) were significantly associated with second malignancies.
CONCLUSIONS
Compared with the general population, an increased incidence of second malignancies was observed in the patients with esophageal cancer in the present study even after definitive treatment. Careful follow-up is required, especially in patients at a higher risk of second malignancies.
Identifiants
pubmed: 31730285
doi: 10.1002/cam4.2688
pmc: PMC6943156
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
394-400Informations de copyright
© 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
Références
Cancer Lett. 2009 Mar 18;275(2):240-6
pubmed: 19036500
Cancer Med. 2018 Sep;7(9):4193-4201
pubmed: 30047253
J Am Coll Surg. 2005 Aug;201(2):188-93
pubmed: 16038814
Gastroenterology. 2018 Jan;154(2):360-373
pubmed: 28823862
BMC Cancer. 2019 Jan 3;19(1):3
pubmed: 30606157
Carcinogenesis. 2005 May;26(5):1008-12
pubmed: 15718256
PLoS One. 2015 Jan 30;10(1):e0116384
pubmed: 25635388
Clin Cancer Res. 2007 Jan 15;13(2 Pt 1):559-65
pubmed: 17255278
Ann Surg. 2000 Aug;232(2):225-32
pubmed: 10903602
Cancer Med. 2020 Jan;9(1):394-400
pubmed: 31730285
Int J Clin Oncol. 2018 Aug;23(4):652-658
pubmed: 29520523
Ann Oncol. 2019 Jan 1;30(1):34-43
pubmed: 30475943
Gastroenterology. 2009 Nov;137(5):1768-75
pubmed: 19698717
Esophagus. 2015;12:1-30
pubmed: 25620903
J Clin Oncol. 2003 Dec 1;21(23):4336-41
pubmed: 14645422
Dis Esophagus. 2012 Aug;25(6):505-11
pubmed: 22067063
J Epidemiol. 2005 Jun;15 Suppl 2:S212-9
pubmed: 16127236
Cancer. 1953 Sep;6(5):963-8
pubmed: 13094644
CA Cancer J Clin. 2015 Mar;65(2):87-108
pubmed: 25651787
Cancer Epidemiol Biomarkers Prev. 2008 Jun;17(6):1543-9
pubmed: 18559572
Tumori. 2015 May-Jun;101(3):328-33
pubmed: 25908032
Esophagus. 2018 Jul;15(3):127-152
pubmed: 29948477