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Wang Y, Song W, Wang H, Zhu G, Li Y, Wang Z, Li W, Che G. Increased risk of subsequent primary lung cancer among female hormone-related cancer patients: A meta-analysis based on over four million cases. Chin Med J (Engl) 2024; 137:1790-1801. [PMID: 38973242 DOI: 10.1097/cm9.0000000000003132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The incidence rate of lung cancer in women has significantly increased over the past decade, and previous evidence has indicated a significant relationship between the elevated levels of sex hormones and the risk of lung cancer. Therefore, we hypothesized that female hormone-related cancer (FHRC) patients, including breast, endometrial, cervical, and ovarian cancer patients, may experience a higher risk of developing subsequent lung cancer. This meta-analysis aimed to identify the risk of lung cancer among FHRC patients compared to the general population. METHODS The PubMed, Web of Science, EMBASE, Cochrane Library, and CNKI databases were searched up to May 11, 2022. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were used to identify the risk of subsequent lung cancer after FHRC. Subgroup analyses based on the follow-up time and tumor type were also conducted. RESULTS A total of 58 retrospective cohort studies involving 4,360,723 FHRC participants were included. The pooled results demonstrated that FHRC patients had a significantly increased risk of developing subsequent primary lung cancer (SIR = 1.61, 95% CI: 1.48-1.76, P <0.001). Subgroup analysis revealed an obvious trend of increasing lung cancer risk over time (SIRs for <5 years, ≥5 years, ≥10 years, ≥20 years, and ≥30 years after FHRC: 1.32, 1.59, 1.57, 1.68, and 1.95, respectively). In addition, subgroup analysis stratified by tumor type indicated an increased risk of developing subsequent lung cancer after breast (SIR = 1.25, P <0.001), endometrial (SIR = 1.40, P = 0.019), cervical (SIR = 2.56, P <0.001), and ovarian cancer (SIR = 1.50, P = 0.010). CONCLUSION FHRC patients are more likely to develop lung cancer than the general population. Furthermore, the increased risk of subsequent primary lung cancer is more obvious with a longer survival time and is observed in all types of hormone-related cancer. REGISTRATION International Platform of Registered Systematic Review and Meta-analysis Protocols: No. INPLASY202270044; https://inplasy.com/.
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Affiliation(s)
- Yan Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenpeng Song
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Haoyu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Guonian Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Yangqian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zhoufeng Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Networks, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Institute of Respiratory Health, Frontiers Science Center for Disease-related Molecular Networks, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Gong S, Li G, Li D, Liu Y, Wu B. The risk for subsequent primary lung cancer after cervical carcinoma: A quantitative analysis based on 864,627 cases. PLoS One 2024; 19:e0305670. [PMID: 38913637 PMCID: PMC11195986 DOI: 10.1371/journal.pone.0305670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/03/2024] [Indexed: 06/26/2024] Open
Abstract
PURPOSE To compare the risk of developing subsequent primary lung cancer among cervical cancer patients and the general population. METHODS Several databases were searched from inception to April 25, 2023. The standard incidence ratios (SIRs) with 95% confidence intervals (CIs) were combined to identify the risk for second primary lung cancer after cervical carcinoma. Subgroup analyses based on the follow-up period, age, degree of malignancy and source of SIR were conducted. All the statistical analyses were performed with STATA 15.0 software. RESULTS A total of 22 retrospective studies involving 864,627 participants were included. The pooled results demonstrated that cervical cancer patients had a significantly greater risk for lung cancer than did the general population (SIR = 2.63, 95% CI: 2.37-2.91, P<0.001). Furthermore, subgroup analyses stratified by follow-up period (<5 years and ≥5 years), age (≤50 years and <50 years), and degree of malignancy (invasive and in situ) also revealed an increased risk of developing lung cancer among cervical carcinoma patients. CONCLUSION Cervical cancer patients are more likely to develop subsequent primary lung cancer than the general population, regardless of age, follow-up time or degree of malignancy. However, more high-quality prospective studies are still needed to verify our findings.
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Affiliation(s)
- Sheng Gong
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Gang Li
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Dan Li
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Yu Liu
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
| | - Banggui Wu
- Department of Thoracic Surgery, The Public Health Clinical Center of Chengdu, Chengdu, P.R. China
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Zhang F, Yu P, Xu L, Chen X, Du J. Differences of characteristics, influencing factors, and treatment effects on the survival in patients with first and second primary cervical cancer. Prev Med Rep 2023; 36:102504. [PMID: 38116255 PMCID: PMC10728444 DOI: 10.1016/j.pmedr.2023.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
Abstract
To explore the characteristics, influencing factors, and effect of different treatments on the survival in patients with first primary cervical cancer (CC) and second primary CC. Data of 33,934 eligible patients with CC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database in 2004-2015. We also included 176 patients with CC from the Affiliated Dongyang Hospital of Wenzhou Medical University. Univariate and multivariate Cox proportional hazard models were used to screen the potential influencing factors associated with the survival in patients with hazard ratios (HRs) and 95 % confidence intervals (CIs). Subgroup analyses of age, American Joint Committee on Cancer (AJCC) stages, tumor grades and histologic types were conducted to explore the association between different treatments and survival in different populations. The 5-year mortality was 43.08 % for patients with first primary CC and that was 58.13 % for patients with second primary CC. We found that the relationships between age, histologic type, tumor grade, tumor size, AJCC tumor-node-metastasis (TNM) stage, surgery, chemotherapy, radiotherapy and the first primary CC and second primary CC were different (all P < 0.05). Additionally, the results of subgroup analyses indicated that the choice of surgery, chemotherapy, and radiotherapy should be adjusted according to the different health conditions of the patients. In conclusion, the causal relationship between characteristics, influencing factors, and treatments and survival in patients with primary CC diagnosed as different time periods are needed further exploration.
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Affiliation(s)
- Fan Zhang
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Ping Yu
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Lixia Xu
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Xuwei Chen
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
| | - Junqiang Du
- Department of Gynecology, Affiliated Dongyang Hospital of Wenzhou Medical University, Jinhua 322100, Zhejiang, PR China
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Xie N, Lin J, Liu L, Deng S, Yu H, Sun Y. Nomograms constructed for predicting diagnosis and prognosis in cervical cancer patients with second primary malignancies: a SEER database analysis. J Cancer Res Clin Oncol 2023; 149:13201-13210. [PMID: 37479758 DOI: 10.1007/s00432-023-05192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Cervical cancer (CC) patients are more likely to develop second primary malignancies (SPMs) than general population. With the advancement in cancer therapy, CC patients are achieving long-term survival, leading SPMs to our attention. Our study aims to establish diagnostic and prognostic nomograms for CC patients with second primary malignancies (CCSPMs) to help make personalized follow-up plans and treatments. METHODS Data of CCSPMs between 2000 and 2019 was extracted from SEER. The proportions and the median interval time of CCSPM onset were calculated. 11 related clinical characteristics, including age, race, marital status, grade, FIGO stage, radiotherapy, chemotherapy, and surgery, were further explore. Logistic and Cox regressions were employed to predict risk factors for CCSPMs diagnosis. Finally, two nomograms were developed to predict the probability occurrence and prognosis of CCSPMs, respectively. RESULTS For diagnostic nomogram construction, 59,178 CC patients were randomly divided into training (n = 41,426) and validation cohorts (n = 17,752). For prognostic nomogram construction, 3527 CCSPMs patients were randomly divided into training (n = 2469) and validation cohorts (n = 1058). The diagnostic nomogram consisting of above 11 independent risk factors (all P < 0.05), had high accuracy (AUCtraining = 0.851 and AUCvalidating = 0.845). The prognostic nomogram integrated with eight independent prognostic factors such as treatments, FIGO stage and TNM stage performed well in predicting 5-year OS (AUCtraining = 0.835 and AUCvalidating = 0.837). CONCLUSION Our diagnostic and prognostic nomograms could facilitate clinicians to quantify individual SPMs risk and survival probabilities and optimize the surveillance recommendations and personalized clinical decision-making.
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Affiliation(s)
- Ning Xie
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Jie Lin
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Linying Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Sufang Deng
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Haijuan Yu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China
| | - Yang Sun
- Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian Province, China.
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Sidhu MS, Singh K, Sood S, Aggarwal R. A dosimetric comparison of intensity-modulated radiotherapy versus rapid arc in gynecological malignancies: Dose beyond planning target volume, precisely 5Gy volume. J Cancer Res Ther 2023; 19:1267-1271. [PMID: 37787294 DOI: 10.4103/jcrt.jcrt_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Introduction Aim of radiotherapy is precise dose delivery with objective of achieving maximum local control and minimal toxicity by decreasing dose to organ at risk (OAR).This aim can be achieved by technologies like intensity-modulated radiotherapy (IMRT) and volumetric arc therapy. However, later offers comparable or even better plan quality with shorter treatment time. It is important to note that low dose regions are also a concern due long-term risk of developing a second cancer after radiotherapy. The objective of our study is to do dosimetric comparison of IMRT vs. Rapid arc (RA) plan in gynecology cancer and specifically to assess dose beyond planning target volume (PTV), precisely 5 Gy volume. Methods Each 20 eligible patients underwent radiotherapy planning on eclipse by both IMRT and RA plans as per institution protocols. Comparative dosimetric analysis of both plans was done by paired sample t-test. PTV metrics compared were D95%, homogenecity index (HI), and conformity index (CI). OAR dose compared were bowel V40 Gy <30%, Rectum V30 Gy <60%, Bladder V45 Gy <35%, and bilateral femur head and neck V30 Gy < 50%. Futhermore, calculated monitor units (MUs) were also compared. Finally, volume of normal tissue beyond the PTV, specifically 5 Gy volume, was compared between plans. Results Dosimetric plan comparison showed statistically significant difference in RA and IMRT plans with improved PTV coverage and better OAR tolerance with RA plan. In addition, MU used were significantly less in RA plan, coupled with reduced V5 Gy volume. Conclusion In sum, RA plans are dosimetrically significantly better compared to IMRT plans in gynecological malignancies in terms of PTV coverage and OAR sparing. Importantly, not only less MU used but also significantly less normal tissue V5 Gy volume is less in RA compared to IMRT plans.
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Affiliation(s)
| | - Kulbir Singh
- Department of Medical Physics, DMCH Cancer Centre, Ludhiana, Punjab, India
| | - Sandhya Sood
- Department of Radiation Oncology, DMCH Cancer Centre, Ludhiana, Punjab, India
| | - Ritu Aggarwal
- Department of Radiation Oncology, DMCH Cancer Centre, Ludhiana, Punjab, India
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Muacevic A, Adler JR, Andine TF, Elleissy Nasef K, Akinwumi B, Oduwole A, Lipscombe C, Ojo AS, Fakorede M. Second Malignancies Following Primary Cervical Cancer Diagnosis: Analysis of the SEER Database. Cureus 2022; 14:e26171. [PMID: 35891874 PMCID: PMC9306408 DOI: 10.7759/cureus.26171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction While mortality following primary cervical cancers (PCCs) continues to decline due to advancements in screening and treatment, a small subset of women who developed PCCs will develop second malignancies after their initial diagnosis. Little is known about these women. Objective This study aims to determine the common second malignancies among patients with primary cervical cancers and the factors associated with improved overall survival. Methodology We conducted a retrospective analysis of all PCCs in the SEER database between 1975 and 2016. We identified a subset of patients who subsequently developed secondary malignancies after a primary cervical cancer diagnosis. We then determined the factors associated with a prolonged latency interval, defined as the time between the PCC diagnosis and a subsequent secondary malignancy diagnosis. In a sub-analysis, we also determined the commonest secondary malignancies following a PCC diagnosis. Results A total of 1,494 patients with cervical cancers developed a second malignancy during the study period. The mean age at diagnosis of the PCCs was 56.0 ± 14.0 years. The mean latency interval between PCC and a subsequent secondary malignancy was 9.6 ± 9.3 years. Cytoreductive surgery (odds ratio (OR) = 1.40; 95% confidence interval (CI) = 1.05-1.86) and radiotherapy (OR = 1.52; 95% CI = 1.14-2.03) during the PCC are associated with a prolonged latency interval. Patients who received chemotherapy (OR = 0.23; 95% CI = 0.16-0.33) or those of Hispanic ethnicity (OR = 0.63; 95% CI = 0.44-0.90) were more likely to develop second malignancies within 10 years after a PCC diagnosis. The most common second malignancies were abdominal malignancies with rectal cancers (12.2%), pancreatic cancers (10.1%), stomach cancers (9.2%), cecum cancers (8.4%), and sigmoid colon cancers (8.3%). Conclusion There is a significant association between Hispanic ethnicity and a shorter latency interval among patients with PCC. The findings from this study may help optimize screening for secondary cancers among cervical cancer survivors.
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Jordan KH, Beverly Hery CM, Zhang X, Paskett ED. Low Rates of Dual-Site and Concordant Oral-Cervical Human Papillomavirus Infections and Cancers: A Systematic Review. Front Oncol 2022; 12:848628. [PMID: 35425709 PMCID: PMC9004260 DOI: 10.3389/fonc.2022.848628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The oral-cervical human papillomavirus (HPV) infection/cancer relationship is not well established. Oral-cervical HPV studies were reviewed to assess dual-site occurrence, HPV type concordance, and study quality/deficiencies. Methods PubMed, EMBASE, Ovid Medline, and Web of Science were searched between 1/1/1990 and 8/10/2021 for studies investigating HPV infections/cancers and type concordance between the oral cavity/oropharynx and cervix. Dual-site and concordant HPV infection rates were summarized as percentages; cancer diagnoses studies were summarized using standardized incidence ratios (SIR). The Quality Assessment Tool for Quantitative Studies (QATQS) evaluated study methodology. Results One hundred fourteen papers were identified. Most were cross-sectional (n=79, 69%), involved synchronous dual-site HPV testing (n=80, 70%), did not report HPV type concordance (n=62, 54%), and achieved moderate methodological QATQS ratings (n=81, 71%). The overall dual-site infection rate averaged 16%; the HPV type concordance rate averaged 41%, among those dually-infected women. Most HPV-related cancer diagnoses studies reported increased secondary cancer risk, with SIRs generally ranging from 1.4 to 29.4 for secondary cervical cancer after primary oral cancer and from 1.4 to 6.3 for secondary oral cancer after primary cervical cancer. Conclusion/Impact Oral-cervical HPV infections/cancers remain understudied. Future research should use stronger methodologies and HPV concordance analyses to better understand oral-cervical HPV epidemiology.
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Affiliation(s)
- Kelsey H Jordan
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Chloe M Beverly Hery
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH, United States.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
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Liao SC, Yeh HZ, Chang CS, Chen WC, Muo CH, Sung FC. Colorectal Cancer Risk in Women with Gynecologic Cancers-A Population Retrospective Cohort Study. J Clin Med 2021; 10:jcm10143127. [PMID: 34300293 PMCID: PMC8303695 DOI: 10.3390/jcm10143127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/03/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022] Open
Abstract
We conducted a retrospective cohort study to evaluate the subsequent colorectal cancer (CRC) risk for women with gynecologic malignancy using insurance claims data of Taiwan. We identified patients who survived cervical cancer (N = 25,370), endometrial cancer (N = 8149) and ovarian cancer (N = 7933) newly diagnosed from 1998 to 2010, and randomly selected comparisons (N = 165,808) without cancer, matched by age and diagnosis date. By the end of 2011, the incidence and hazard ratio (HR) of CRC were estimated. We found that CRC incidence rates were 1.26-, 2.20-, and 1.61-fold higher in women with cervical, endometrial and ovarian cancers, respectively, than in comparisons (1.09/1000 person-years). The CRC incidence increased with age. Higher adjusted HRs of CRC appeared within 3 years for women with endometrial and ovarian cancers, but not until the 4th to 7th years of follow up for cervical cancer survivals. Cancer treatments could reduce CRC risks, but not significantly. However, ovarian cancer patients receiving surgery alone had an incidence of 3.33/1000 person-years for CRC with an adjusted HR of 3.79 (95% CI 1.11-12.9) compared to patients without any treatment. In conclusion, gynecologic cancer patients are at an increased risk of developing CRC, sooner for those with endometrial or ovarian cancer than those with cervical cancer.
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Affiliation(s)
- Szu-Chia Liao
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; (S.-C.L.); (H.-Z.Y.); (C.-S.C.)
- Department of Public Health, China Medical University, Taichung 404, Taiwan
| | - Hong-Zen Yeh
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; (S.-C.L.); (H.-Z.Y.); (C.-S.C.)
- Department of Internal Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan; (S.-C.L.); (H.-Z.Y.); (C.-S.C.)
| | - Wei-Chih Chen
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan;
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan;
- Department of Health Services Administration, China Medical University, Taichung 404, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung 413, Taiwan
- Correspondence: ; Tel.: +886-4-2296-7979 (ext. 6220)
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Li R, Zhang Y, Ma B, Tan K, Lynn HS, Wu Z. Survival analysis of second primary malignancies after cervical cancer using a competing risk model: implications for prevention and surveillance. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:239. [PMID: 33708866 PMCID: PMC7940922 DOI: 10.21037/atm-20-2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Previous studies have reported an increased risk for second primary malignancies (SPMs) after cervical cancer (CC). This study aims to quantify and assess the risk of developing SPMs in long-term survivors of CC. Methods A population-based cohort of CC patients aged 20–79 years was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. A competing risk model and corresponding nomogram were constructed to predict the 3-, 5-, and 10-year cumulative risks of SPMs. A Fine-Gray plot was created to validate the model. Finally, we performed decision curve analysis (DCA) to evaluate the clinical usefulness of the model by calculating the net benefit. Results A total of 34,295 patients were identified, and approximately 6.3% of the study participants developed SPMs. According to the multivariable competing-risk model, older black CC survivors with localized disease who were treated with radiation therapy were more susceptible to SPMs. The 3-, 5-, and 10-year cumulative incidences of SPMs were 2.5%, 3.6%, and 6.2%, respectively. Calibration curves showed good agreement between the predicted and observed models. The DCA yielded a wide range of risk thresholds at which the net benefits could be obtained from our proposed model. Conclusions This study provides physicians with a practical, individualized prognostic estimate to assess the risk of SPMs among CC survivors. CC survivors remain at a high risk of developing SPMs, and further surveillance should focus especially on the patients with black race, older age, localized disease, or those having received radiation therapy.
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Affiliation(s)
- Runmei Li
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Yue Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Bingqing Ma
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Kangming Tan
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Henry S Lynn
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
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Hung H, You J, Chiang J, Hsieh P, Chiang S, Lai C, Tasi W, Yeh C, Chern Y, Hsu Y. Clinicopathological characteristics and outcomes of metachronous rectal cancer in patients with a history of cervical cancer with and without remote radiotherapy: Reports of 45 cases. Medicine (Baltimore) 2020; 99:e21328. [PMID: 32791729 PMCID: PMC7387061 DOI: 10.1097/md.0000000000021328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.
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Risk of second primary cancers among survivors of gynecological cancers. Gynecol Oncol 2020; 158:719-726. [PMID: 32616403 DOI: 10.1016/j.ygyno.2020.06.492] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Survivors of gynecologic cancers have an increased risk of developing second primary cancers (SPC); however it is unclear which sites have higher risks. We aimed to ascertain risk of SPC among survivors of gynecological cancer, and identify anatomic sites at risk of SPC. METHODS We queried the Surveillance, Epidemiology and End Results database (2000-2016) for confirmed cases of index gynecological (cervix uteri [cervical], corpus and uterus [endometrial], ovarian, vaginal, and vulvar) cancers. Risk of SPC was estimated using standardized incidence ratios (SIRs: observed/expected cases) and excess absolute risks (EARs: observed - expected cases) per 10,000 person-years at risk (PYR). SIRs and EARs were stratified by index anatomic site and latency interval. RESULTS Among the cohort of 301,210 gynecological cancer survivors, 19,005 (6.31%) developed an SPC (SIR = 1.16; 95% CI, 1.15-1.18 and EAR = 17.2 cases per 10,000 PYR) compared with the general population. All gynecological cancer survivors (except survivors of ovarian) had a significant risk of developing SPC (SIR range 1.06-2.16), with survivors of vulvar cancer having the highest risk (SIR = 2.16; 95% CI, 2.06-2.27; EAR = 139.5 per 10,000 PYR). Risk of SPC was highest within the first 5 years post-diagnosis for survivors of cervical, vulvar and vaginal cancers. CONCLUSIONS While most index gynecological cancer sites are associated with increased risk of SPC, risk is highest among survivors of vulvar cancer. These findings have the potential to inform lifelong surveillance recommendations for gynecological cancer survivors.
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Gilbert DC, Wakeham K, Langley RE, Vale CL. Increased risk of second cancers at sites associated with HPV after a prior HPV-associated malignancy, a systematic review and meta-analysis. Br J Cancer 2018; 120:256-268. [PMID: 30482913 PMCID: PMC6342987 DOI: 10.1038/s41416-018-0273-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/20/2018] [Accepted: 09/04/2018] [Indexed: 01/17/2023] Open
Abstract
Background High-risk human papilloma viruses (HPV) are a causative agent of anogenital and oropharyngeal cancers. Patients treated for a preinvasive or invasive HPV-associated cancer may be at increased risk of a second such malignancy. Methods We performed a systematic review and random effects meta-analysis to estimate the risk of HPV-associated cancer after prior diagnosis. Studies reporting second cancers at anogenital and oropharyngeal sites after prior diagnoses (preinvasive/invasive HPV-associated cancer) were identified. Studies reporting standardised incidence ratios (SIRs) were included in formal meta-analyses of second cancer risk. (PROSPERO ID: CRD42016046974). Results Searches returned 5599 titles, including 60 unique, eligible studies. Thirty-two (98 comparisons) presented SIRs for second cervical, anal, vulvo-vaginal, penile, and/or oropharyngeal cancers, included in the meta-analyses. All studies (and 95/98 comparisons) reported increased cancers in the population with previous HPV-associated cancer when compared to controls. Pooled SIRs for second primary cancers ranged from 1.75 (95% CI 0.66−4.67) for cervical cancer after primary anal cancer, to 13.69 (95% CI 8.56−21.89) for anal cancer after primary vulvo-vaginal cancer. Conclusions We have quantified the increased risk of second HPV-associated cancer following diagnosis and treatment for initial cancer or preinvasive disease. This has important implications for follow-up, screening, and future therapeutic trials.
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Affiliation(s)
- Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London, UK. .,Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, UK.
| | - Katie Wakeham
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London, UK
| | - Claire L Vale
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London, UK
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Suk R, Mahale P, Sonawane K, Sikora AG, Chhatwal J, Schmeler KM, Sigel K, Cantor SB, Chiao EY, Deshmukh AA. Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers. JAMA Netw Open 2018; 1:e181999. [PMID: 30646145 PMCID: PMC6324459 DOI: 10.1001/jamanetworkopen.2018.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs). OBJECTIVES To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018. MAIN OUTCOMES AND MEASURES The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression. RESULTS From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased. CONCLUSIONS AND RELEVANCE According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.
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Affiliation(s)
- Ryan Suk
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Kalyani Sonawane
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Andrew G. Sikora
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth Y. Chiao
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashish A. Deshmukh
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
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Janulionis E, Samerdokiene V, Valuckas KP, Atkocius V, Rivard MJ. Second primary malignancies after high-dose-rate 60Co photon or 252Cf neutron brachytherapy in conjunction with external-beam radiotherapy for endometrial cancer. Brachytherapy 2018; 17:768-774. [DOI: 10.1016/j.brachy.2018.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/15/2018] [Accepted: 05/10/2018] [Indexed: 01/17/2023]
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Neumann F, Jégu J, Mougin C, Prétet JL, Guizard AV, Lapôtre-Ledoux B, Bara S, Bouvier V, Colonna M, Troussard X, Trétarre B, Grosclaude P, Velten M, Woronoff AS. Risk of second primary cancer after a first potentially-human papillomavirus-related cancer: A population-based study. Prev Med 2016; 90:52-8. [PMID: 27370167 DOI: 10.1016/j.ypmed.2016.06.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 01/16/2023]
Abstract
Human papillomaviruses (HPV) are involved in the development of anogenital and head and neck cancers. The purpose of this study was to assess the risk of developing a second primary cancer (SPC) after a first potentially-HPV-related cancer, and to analyze the sites where SPCs most frequently occurred in these patients. All patients with a first cancer diagnosed between 1989 and 2004, as recorded by 10 French cancer registries, were followed up until December 31, 2007. Only invasive potentially-HPV-related cancers (namely, cervical, vagina, vulva, anal canal, penile, oropharynx, tongue and tonsil) were included. Standardized Incidence Ratios (SIRs) were calculated to assess the risk of SPC. A multivariate Poisson regression model was used to model SIRs separately by gender, adjusted for the characteristics of the first cancer. 10,127 patients presented a first potentially-HPV-related cancer. The overall SIR was 2.48 (95% CI, 2.34-2.63). The SIR was 3.59 (95% CI, 3.33-3.86) and 1.61 (95% CI, 1.46-1.78) in men and women respectively. The relative risk of potentially-HPV-related SPC was high among these patients (SIR=13.74; 95% CI, 8.80-20.45 and 6.78; 95% CI, 4.61-9.63 for men and women, respectively). Women diagnosed in the most recent period (2000-2004) showed a 40% increase of their relative risk of SPC as compared with women diagnosed between 1989 and 1994 (ratio of SIRs=1.40; 95% CI, 1.06-1.85). HPV cancer survivors face an increased risk of SPC, especially second cancer. Clinicians may consider this increased risk of developing HPV-related SPC during follow-up to improve subsequent cancer prevention in these patients.
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Affiliation(s)
- Florent Neumann
- Registre des tumeurs du Doubs et du Territoire de Belfort, University Hospital Besançon, F-25000 Besançon, France.
| | - Jérémie Jégu
- Registre des cancers du Bas-Rhin, Laboratoire d'Épidémiologie et de Santé Publique, EA3430, FMTS, University of Strasbourg, F-67085 Strasbourg, France; Service de santé publique, University Hospital of Strasbourg, F-67091 Strasbourg, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Christiane Mougin
- University of Franche-Comte, EA 3181, FED4234, LabExLipSTIC ANR-11-LABX-0021-FED4234, CIC-1431 F-25000 Besançon, France; University Hospital Besançon, F-25000 Besançon, France
| | - Jean-Luc Prétet
- University of Franche-Comte, EA 3181, FED4234, LabExLipSTIC ANR-11-LABX-0021-FED4234, CIC-1431 F-25000 Besançon, France; University Hospital Besançon, F-25000 Besançon, France
| | - Anne-Valérie Guizard
- Registre général des tumeurs du Calvados, Cancers & Préventions - U 1086 Inserm, Centre François Baclesse, F-14076, Caen 05, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Bénédicte Lapôtre-Ledoux
- Registre du cancer de la Somme, Service Épidémiologie Hygiène et Santé Publique, University Hospital Nord, F-80054 Amiens, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Simona Bara
- Registre des cancers de la Manche, Hospital of Cotentin, F-50102 Cherbourg-Octeville, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Véronique Bouvier
- Registre des tumeurs digestives du Calvados, Cancers & Préventions - U 1086 Inserm, Centre François Baclesse, BP 5026, F-14076, Caen 05, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Marc Colonna
- Registre des cancers de l'Isère, University Hospital Grenoble, BP 217, F-38043, Grenoble 9, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Xavier Troussard
- Registre des hémopathies malignes de Basse-Normandie, Unité Fonctionnelle Hospitalo-Universitaire n°0350, University Hospital Caen, F-14033 Caen, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Brigitte Trétarre
- Registre des tumeurs de l'Hérault, Centre de Recherche, F-34298, Montpellier 5, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Pascale Grosclaude
- Registre des cancers du Tarn, BP 37, F-81001 Albi, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Michel Velten
- Registre des cancers du Bas-Rhin, Laboratoire d'Épidémiologie et de Santé Publique, EA3430, FMTS, University of Strasbourg, F-67085 Strasbourg, France; Service de santé publique, University Hospital of Strasbourg, F-67091 Strasbourg, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
| | - Anne-Sophie Woronoff
- Registre des tumeurs du Doubs et du Territoire de Belfort, University Hospital Besançon, F-25000 Besançon, France; University of Franche-Comte, EA 3181, FED4234, LabExLipSTIC ANR-11-LABX-0021-FED4234, CIC-1431 F-25000 Besançon, France; Francim: Réseau français des registres des cancers, F-31073 Toulouse, France
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Wen CT, Fu JY, Wu CF, Hsieh MJ, Liu YH, Wu YC, Tsai YH, Wu CY. Survival impact of locoregional metachronous malignancy in survival of lung cancer patients who received curative treatment. J Thorac Dis 2016; 8:1139-48. [PMID: 27293830 DOI: 10.21037/jtd.2016.04.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Metachronous malignancy is also found in the lung cancer population and may be identified before or after diagnosis of lung cancer. No prior studies have documented lung cancer patients with metachronous malignancy and its survival impact in this population. The aim of this study was to try to clarify the survival impact of locoregional metachronous malignancy in the lung cancer population with resectable disease from a pathology point of view. METHODS From January 2005 to December 2009, 199 lung cancer patients received curative treatment in Chang Gung Memorial Hospital, of which 34 were identified as having lung cancer and metachronous malignancy and 165 patients as having lung cancer only. Clinico-pathologic factors were collected from the medical records. Differences in clinical presentations between the two groups and survival impact were further analyzed. RESULTS Of these patients, 165 patients (82.9%) had lung cancer only (lung cancer group), and the remaining 34 patients (17.1%) had lung cancer and metachronous malignancy (metachronous malignancy group). There were no significant differences in clinical characteristics between the two groups. The disease free survival (P=0.3199) and overall survival (P=0.71) between these two groups showed no statistically significant difference. Metachronous malignancy only showed survival impact in lung cancer patients with pathologic stage IIIA (P=0.0389). CONCLUSIONS Metachronous malignancy is also seen in the lung cancer population and may be identified before or after diagnosis of lung cancer. Locoregional metachronous malignancy has no survival impact on lung cancer patients who receive curative treatment. Anatomic resection with regional lymph node (LN) dissection is recommended if different tumor cell type and resectable disease are confirmed.
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Affiliation(s)
- Chi-Tsung Wen
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Jui-Ying Fu
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Ching-Feng Wu
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Ming-Ju Hsieh
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Yun-Hen Liu
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Yi-Cheng Wu
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Ying-Huang Tsai
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
| | - Ching-Yang Wu
- 1 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan ; 2 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan ; 3 Division of Chest and Critical Care, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Chiayi, Taiwan
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Lost workdays in uterine cervical cancer survivors compared to the general population: impact of treatment and relapse. J Cancer Surviv 2015; 10:514-23. [DOI: 10.1007/s11764-015-0496-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/02/2015] [Indexed: 01/03/2023]
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Teng CJ, Huon LK, Hu YW, Yeh CM, Chao Y, Yang MH, Chen TJ, Hung YP, Liu CJ. Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1803. [PMID: 26512575 PMCID: PMC4985389 DOI: 10.1097/md.0000000000001803] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 11/26/2022] Open
Abstract
To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.
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Affiliation(s)
- Chung-Jen Teng
- From the Institute of Public Health, National Yang-Ming University, Taipei (C-JT, Yi-PH); Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City (C-JT); School of Medicine, National Yang-Ming University (C-JT, Y-WH, YC, M-HY, T-JC, Yi-PH, C-JL); Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital (L-KH); School of Medicine, Fu Jen Catholic University (L-KH); Department of Oncology (Y-WH, YC); Department of Family Medicine (C-MY, T-JC); Division of Gastroenterology and Hepatology, Department of Medicine (YC); Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (M-HY, Yi-PH, C-JL); and Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan (C-JL)
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Nikolaidis C, Nena E, Panagopoulou M, Balgkouranidou I, Karaglani M, Chatzaki E, Agorastos T, Constantinidis TC. PAX1 methylation as an auxiliary biomarker for cervical cancer screening: a meta-analysis. Cancer Epidemiol 2015; 39:682-6. [PMID: 26234429 DOI: 10.1016/j.canep.2015.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/29/2015] [Accepted: 07/17/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Several studies have implicated PAX1 epigenetic regulation in cervical neoplasia. The aim of this meta-analysis was to assess PAX1 gene methylation as a potential biomarker in cervical cancer screening. METHODS A systematical search of all major databases was performed, in order to include all relevant publications in English until December 31(st) 2014. Studies with insufficient data, conducted in experimental models or associated with other comorbidities were excluded from the meta-analysis. Summary receiver operating characteristics (SROC) for Cervical Intraepithelial Neoplasia grade 2 or worse (CIN2(+)) versus normal, and CIN grade 3 or worse (CIN3(+)) versus normal, were estimated using the bivariate model. RESULTS Out of the 20 initially included studies, finally 7 (comprising of 1385 subjects with various stages of CIN and normal cervical pathology) met the inclusion criteria. The sensitivity of CIN2(+) versus normal was estimated to be 0.66 (CI 95%, 0.46-0.81) and the specificity 0.92 (CI 95%, 0.88-0.95). On the other hand, the sensitivity of CIN3(+) versus normal was 0.77 (CI 95%, 0.58-0.89) and the specificity 0.92 (CI 95%, 0.88-0.94). Moreover, the area under the curve (AUC) in the former case was 0.923, and in the latter 0.931. CONCLUSION The results of this meta-analysis support the utility of PAX1 methylation as an auxiliary biomarker in cervical cancer screening. PAX1 could be used effectively to increase the specificity of HPV DNA by detecting women with more advanced cervical abnormalities.
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Affiliation(s)
- Christos Nikolaidis
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece.
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Maria Panagopoulou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Ioanna Balgkouranidou
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Makrina Karaglani
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Ekaterini Chatzaki
- Laboratory of Pharmacology, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
| | - Theodoros Agorastos
- IV. University Clinic of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Hippokrateion Hospital, Thessaloniki 54642, Greece
| | - Theodoros C Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, 68100, Greece
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Samerdokiene V, Valuckas KP, Janulionis E, Atkocius V, Rivard MJ. Second primary malignancies after radiotherapy including HDR (252)Cf brachytherapy for cervical cancer. Brachytherapy 2015; 14:898-904. [PMID: 26194049 DOI: 10.1016/j.brachy.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/28/2015] [Accepted: 06/16/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Second primary malignancies (SPMs) are among the most serious late adverse effects after radiotherapy experienced over time by the increasing population of cancer survivors worldwide. The study aim was to determine the rate and distribution of SPMs for neutron- and photon-emitting brachytherapy (BT) sources for patients treated for cervical cancer. METHODS AND MATERIALS The cohort comprised 662 patients with invasive cervical cancer (Stages IIB and IIIB) and contributed 5,224 patient-years (PY) of observation. These patients were treated by radiotherapy during the 1989-1999 year period with cobalt-60 source ((60)Co) teletherapy. The first group of patients (N = 375; 3,154 PY) received high-dose-rate (HDR) californium-252 source ((252)Cf) BT, whereas the second group (N = 287; 2,070 PY) received HDR (60)Co BT. RESULTS Over a 25-year period, 35 SPMs were observed, amounting to 5.3% of all observed patients: in 16 (2.4%) heavily, 2 (0.3%) moderately, 14 (2.1%) lightly irradiated body sites, and 3 (0.5%) other sites. Of these, 21 cases (5.6%) were observed in the HDR (252)Cf BT group, whereas 14 cases (4.9%) were observed in the HDR (60)Co BT group. Exposures received during (60)Co teletherapy and HDR BT with either (252)Cf or (60)Co had statistically equivalent (p = 0.68) effects on SPM development. CONCLUSIONS Cure rates are improving, and therefore, there are more long-term survivors from cervical cancer. This study shows no significant difference in rates or distribution of SPMs in women treated with neutron BT compared with photon BT (p = 0.68). After reviewing related literature and our research results, it is evident that a detailed investigation of SPM frequency, localization, and dose to adjacent organs is a suitable topic for further research.
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Affiliation(s)
- Vitalija Samerdokiene
- Scientific Research Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania.
| | | | - Ernestas Janulionis
- Radiation and Medical Oncology Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Vydmantas Atkocius
- Scientific Research Center, National Cancer Institute, Vilnius University, Vilnius, Lithuania
| | - Mark J Rivard
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
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Lim MC, Won YJ, Lim J, Kim YJ, Seo SS, Kang S, Lee ES, Oh JH, Kim JY, Park SY. Second Primary Cancer after Diagnosis and Treatment of Cervical Cancer. Cancer Res Treat 2015; 48:641-9. [PMID: 26194366 PMCID: PMC4843727 DOI: 10.4143/crt.2014.326] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/29/2015] [Indexed: 12/13/2022] Open
Abstract
Purpose This study was conducted to investigate the incidence and survival outcomes of second primary cancers after the diagnosis of cervical cancer. Materials and Methods Data from the Korea Central Cancer Registry between 1993 and 2010 were reviewed and analyzed. Standardized incidence ratios (SIRs) of second primary cancers among women with cervical cancer were analyzed. Kaplan-Meier survival curves were constructed for cervical cancer patients with or without a second primary cancer. Results Among 72,805 women with cervical cancer, 2,678 (3.68%) developed a second primary cancer within a mean follow-up period of 7.34 years. The overall SIR for a second cancer was 1.08 (95% confidence interval, 1.04 to 1.12). The most frequent sites of second primary cancers were the vagina, bone and joints, vulva, anus, bladder, lung and bronchus, corpus uteri, and esophagus. However, the incidence rates of four second primary cancers (breast, rectum, liver, and brain) were decreased. The 5-year and 10-year overall survival rates were 78.3% and 72.7% in all women with cervical cancer, and for women with a second primary cancer, these rates were 83.2% and 65.5% from the onset of cervical cancer and 54.9% and 46.7% from the onset of the second primary cancer, respectively. Conclusion The incidence rates of second primary cancers were increased in women with cervical cancer compared to the general population, with the exception of four decreasing cancers. The 10-year overall survival rates were decreased in cervical cancer patients with a second primary cancer.
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Affiliation(s)
- Myong Cheol Lim
- Gynecologic Cancer Branch, National Cancer Center, Goyang, Korea.,Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Jiwon Lim
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Yeon-Joo Kim
- Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | - Sang Soo Seo
- Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Gynecologic Cancer Branch, National Cancer Center, Goyang, Korea.,Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Joo-Young Kim
- Center for Uterine Cancer, National Cancer Center, Goyang, Korea
| | - Sang-Yoon Park
- Gynecologic Cancer Branch, National Cancer Center, Goyang, Korea.,Center for Uterine Cancer, National Cancer Center, Goyang, Korea
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Dost F, Ford PJ, Farah CS. Heightened risk of second primary carcinoma of the head and neck following cervical neoplasia. Head Neck 2013; 36:1132-7. [DOI: 10.1002/hed.23417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 04/16/2013] [Accepted: 06/10/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Fatima Dost
- The University of Queensland; University of Queensland Centre for Clinical Research; Herston Queensland Australia
- The University of Queensland; School of Dentistry; Brisbane Queensland Australia
| | - Pauline J. Ford
- The University of Queensland; University of Queensland Centre for Clinical Research; Herston Queensland Australia
- The University of Queensland; School of Dentistry; Brisbane Queensland Australia
| | - Camile S. Farah
- The University of Queensland; University of Queensland Centre for Clinical Research; Herston Queensland Australia
- The University of Queensland; School of Dentistry; Brisbane Queensland Australia
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Moore MA. Overview of Cancer Registration Research in the Asian Pacific from 2008-2013. Asian Pac J Cancer Prev 2013; 14:4461-84. [DOI: 10.7314/apjcp.2013.14.8.4461] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chen MF, Yang YH, Lai CH, Chen PC, Chen WC. Outcome of patients with esophageal cancer: a nationwide analysis. Ann Surg Oncol 2013; 20:3023-30. [PMID: 23525703 DOI: 10.1245/s10434-013-2935-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Esophageal cancer is 1 of the 10 most common cancers and is a particular devastating form of cancer worldwide. More than 90% patients with esophageal cancer in Taiwan have squamous cell carcinoma (SCC). In the present study, we assessed the factors affecting survival of patients with esophageal cancer using data from Taiwan, a high-incidence area for esophageal SCC. METHODS We performed a retrospective review of 12,482 patients who were newly diagnosed with esophageal cancer from 1998 to 2007. The data were obtained from the National Health Insurance Research Database in Taiwan. Study participants were followed-up until the end of 2008. RESULTS Of the 12,482 patients, 11,490 (92.1%) were male with a median age of 60 years, and 992 (7.9%) were female with a median age of 71 years at the time of diagnosis. The overall 1-, 2-, 5-, and 10-year survival rates after diagnosis were 40.3, 22.9, 12.8, and 7.6%, respectively. Among parametric models for esophageal cancer prognosis, male sex, no curative treatment (surgery and/or radiotherapy), old age, and low socioeconomic status were significantly associated with shorter survival. Furthermore, curative treatment with surgery improved the survival of esophageal cancer patients more significantly compared with patients who undergo definite radiotherapy. CONCLUSIONS Our data indicated that age, sex, and curative treatment were significant predictors of lifetime survival in patients with esophageal cancer. The overall survival rates of patients with esophageal cancer are relatively low, while survival of patients who undergo surgery is improved significantly.
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Affiliation(s)
- Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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