Impact of prior malignancy on outcomes of stage IV esophageal carcinoma: SEER based study

Outcomes and Prognostic Factors of Patients with Unresectable or Metastatic Esophageal Squamous Cell Carcinoma Undergoing Immunotherapy- Versus Chemotherapy-Based Regimens: Systematic Review and Pooled Analyses

OBJECTIVE

Immunotherapy-based regimens (IMT) versus cytotoxic chemotherapy (CHT) improved overall survival (OS) of patients with unresectable or metastatic esophageal squamous cell carcinoma (mESCC), but the role of prognostic variables is unclear. The study aims to explore the interaction of prognostic factors with survival after IMT or CHT.

METHODS

A systematic review was performed to select trials comparing IMT and CHT regimens in mESCC patients. A meta-analysis of upfront IMT + CHT vs. CHT trials evaluated the overall effect size and heterogeneity between studies. In view of the expected differences between chemotherapy and immunotherapy on the survival curve, to better explore the effect of any prognostic variables on OS, before and after progression, the treatment arms were evaluated as independent cohorts, and ten baseline variables were extracted and assessed by linear regression.

RESULTS

Fourteen trials were identified. Seven studies compared upfront CHT + IMT vs. CHT documenting longer OS for CHT + IMT (HR 0.69, CI 0.65-0.72), without heterogeneity (Q = 1.43, p value = 0.968) or differences in the most represented subgroups. Twenty-nine study cohorts were selected from the 14 trials. Median OS and PPS, but not PFS, were significantly increased after IMT compared with CHT. The analysis of baseline variables after CHT documented a favorable prognostic effect for advanced age (β = 0.768, p value = 0.016), involvement of 0-1 metastasis sites (β = 0.943, p value = 0.005), and absence of previous radiation therapy (β =  - 0.939, p value = 0.006), while none of them influenced prognosis after IMT.

CONCLUSION

The introduction of upfront IMT prolonged mESCC patients OS, mostly improving the outcomes of young patients, with multiple metastasis sites and without previous radiotherapy.

A Systematic Review: The Effect of Cancer on the Divorce Rate

Introduction

Research on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate.

Materials and Methods

This systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale.

Results

Of 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate.

Discussion

According to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.

Effect of prior malignancy on the prognosis of gastric cancer and somatic mutation

BACKGROUND

Cancer survivors have a higher risk of developing secondary cancer, with previous studies showing heterogeneous effects of prior cancer on cancer survivors.

AIM

To describe the features and clinical significance of a prior malignancy in patients with gastric cancer (GC).

METHODS

We identified eligible patients from the Surveillance, Epidemiology, and End Results (SEER) database, and compared the clinical features of GC patients with/without prior cancer. Kaplan-Meier curves and Cox analyses were used to assess the prognostic impact of prior cancer on overall survival (OS) and cancer-specific survival (CSS) outcomes. We also validated our results in The Cancer Genome Atlas (TCGA) cohort and compared mutation patterns.

RESULTS

In the SEER dataset, of the 35492 patients newly diagnosed with GC between 2004 and 2011, 4,001 (11.3%) had at least one prior cancer, including 576 (1.62%) patients with multiple cancers. Patients with a prior cancer history tended to be elderly, with a more localized stage and less positive lymph nodes. The prostate (32%) was the most common initial cancer site. The median interval from initial cancer diagnosis to secondary GC was 68 mo. By using multivariable Cox analyses, we found that a prior cancer history was not significantly associated with OS (hazard ratio [HR]: 1.01, 95% confidence interval [CI]: 0.97–1.05). However, a prior cancer history was significantly associated with better GC-specific survival (HR: 0.82, 95% CI: 0.78–0.85). In TCGA cohort, no significant difference in OS was observed for GC patients with or without prior cancer. Also, no significant differences in somatic mutations were observed between groups.

CONCLUSION

The prognosis of GC patients with previous diagnosis of cancer was not inferior to that of primary GC patients.

Models for Predicting Early Death in Patients With Stage IV Esophageal Cancer: A Surveillance, Epidemiology, and End Results-Based Cohort Study

Background

Despite enormous progress in the stage IV esophageal cancer (EC) treatment, some patients experience early death after diagnosis. This study aimed to identify the early death risk factors and construct models for predicting early death in stage IV EC patients.

Methods

Stage IV EC patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were selected. Early death was defined as death within 3 months of diagnosis, with or without therapy. Early death risk factors were identified using logistic regression analyses and further used to construct predictive models. The concordance index (C-index), calibration curves, and decision curve analyses (DCA) were used to assess model performance.

Results

Out of 4411 patients enrolled, 1779 died within 3 months. Histologic grade, therapy, the status of the bone, liver, brain and lung metastasis, marriage, and insurance were independent factors for early death in stage IV EC patients. Histologic grade and the status of the bone and liver metastases were independent factors for early death in both chemoradiotherapy and untreated groups. Based on these variables, predictive models were constructed. The C-index was .613 (95% confidence interval (CI), [.573–.653]) and .635 (95% CI, [.596–.674]) in the chemoradiotherapy and untreated groups, respectively, while calibration curves and DCA showed moderate performance.

Conclusions

More than 40% of stage IV EC patients suffered from an early death. The models could help clinicians discriminate between low and high risks of early death and strategize individually-tailed therapeutic interventions in stage IV EC patients.

Survival outcomes in esophageal cancer patients with a prior cancer

To achieve a deeper understanding of patients who developed esophageal cancer (EC) as a second primary malignancy, which may help guide in clinical practice for these patients in the future.In the primary cohort, EC patients with a prior malignancy were identified from the surveillance, epidemiology, and end result 18 database. The 5 most common types of prior cancers were picked out based on the frequency of occurrence. In addition, Kaplan-Meier and log-rank tests were performed to investigate the survival impacts of prior cancers on EC patients. Besides, a competing-risk model was constructed to explore the relationship between EC-treatment and EC-specific mortality. In the secondary cohort, patients with stage I-III (N0M0) EC from 2004 to 2014 were enrolled. After propensity score matching, univariate and multivariate Cox analyses were developed to determine the prognostic factors for EC patients.A total of 1199 EC patients with a prior cancer were identified in the primary cohort. The 5 most common sites of prior cancers were prostate, female breast, bladder, lung and bronchus, and larynx. Kaplan-Meier analyses revealed that EC patients with prior prostate cancer and bladder cancer had the best overall survival (OS), while those with prior cancers of larynx and lung and bronchus had the worst OS. Fine and Gray competing risks analysis indicated that the administration of surgery was closely associated with better EC-specific survival (P < .001). In the secondary cohort, multivariate Cox analyses found that age at diagnosis, race, tumor grade, tumor extent, nodal status and metastasis stage, histology, and the administration of surgery were prognostic factors for OS and cancer-specific survival in EC patients. Besides, the existence of a prior cancer was an independent prognostic factor for cancer-specific survival.EC remains to be the most important cause of death in EC patients with a prior cancer. EC related treatment should be actively adopted in patients with a prior cancer, as they were more likely to die from EC than the prior cancer. EC patients with a prior cancer had comparable OS than those without.

Impact of Prior Cancer on the Prognosis of Patients With Laryngeal Cancer: A Population-Based Study Using the Surveillance, Epidemiology, and End Results Database

Background: Little is known about the clinical significance of laryngeal cancer as a subsequent tumor. We aimed to determine the impact of a prior cancer history on the prevalence and prognosis of patients with laryngeal cancer. Methods: We retrospectively reviewed patients diagnosed with laryngeal cancer between 2004 and 2011 in the Surveillance, Epidemiology, and End Results (SEER) database. The t-test and chi-squared test were used to compare variables as appropriate. Matched 1:1 case control-adjusted Kaplan-Meier analyses and Cox regression models were performed to investigate the impact of prior cancer on overall survival (OS). Results: Among 20,987 patients with laryngeal cancer, nearly one-fifth (n = 3,915, 18.65%) had a prior cancer. The top three common prior cancers were prostate (588, 28.1%), lung and bronchus (354, 16.9%), and head and neck (306, 14.6%). A total of 73.4% of the prior cancers were diagnosed within 5 years of the laryngeal cancer diagnosis. Compared to patients without prior cancer, a worse survival was significantly associated with a prior cancer among laryngeal cancer patients, regardless of the interval time of the prior cancer (log-rank tests P < 0.001). Furthermore, prior cancer was an independent predictor of worse OS based on the Cox regression model [hazard ratio (HR) = 1.396, 95% confidence interval, 1.336-1.458]. In addition, patients with prior lung and bronchus cancer tended to have the worst survival (log-rank tests P < 0.001). Conclusions: Prior cancer has an adverse effect on clinical outcomes among patients with laryngeal cancer. These results suggest that individualized treatment should be seriously considered in patients with laryngeal cancer and a history of prior cancer, regardless of the interval time of prior cancer.

Impact of Prior Malignancy on Survival Outcomes of Stage IV Pancreatic Adenocarcinoma: SEER-Based Cohort

PURPOSE

Pancreatic cancer is one of the most fatal malignancies and the fourth leading cause of cancer-related mortality in the USA. Most clinical trials involving pancreatic adenocarcinoma (PAC) patients exclude subjects with a prior malignancy because of the possible effect of prior malignancies on survival. However, no data in the medical literature support this assumption. In this paper, we aim to study the impact of having a prior malignancy on the survival outcomes of stage IV PAC.

METHODS

We used the surveillance, epidemiology, and end results database to review patients with stage IV PAC diagnosed between 1973 and 2014. We calculated overall and pancreatic cancer-specific survival of these patients using unadjusted Kaplan-Meier test and multivariable covariate-adjusted Cox models.

RESULTS

We reviewed 66,874 stage IV PAC patients, of which 4942 had a prior malignancy. Kaplan-Meier and Cox models showed that a history of prior malignancy did not cause significant difference in overall survival (HR = 0.938, 95%CI = 0.880-1.000, p = .052). However, a prior malignancy was associated with a better pancreatic cancer-specific survival (HR = 0.855, 95% CI = 0.796-0.918, p < .001).

CONCLUSION

A prior malignancy before stage IV PAC was not associated with worse survival outcomes. Researchers should take these results into consideration when including/excluding patients to improve the generalizability and accuracy of their results.

Does a history of malignancy impact the survival of a subsequent endometrial adenocarcinoma? Should clinical trials eligibility criteria be revisited?

We aimed at finding the impact of prior malignancies on the survival of patients with endometrial adenocarcinoma using SEER database (from 1973 to 2014). We identified 127,988 patients who were diagnosed with endometrial adenocarcinoma (6485 had a prior malignancy), and we compared the overall and cancer-specific survival based on the presence or absence of a prior malignancy and the latency period between the two diagnoses using Kaplan-Meier test and Cox models. Adjusted cox models showed that a history of a prior malignancy neither affected the overall survival nor the cancer-specific survival of stage IV cases in all latency groups except the one diagnosed within 1 year of the first cancer. Therefore, there is no rational explanation for excluding stage IV endometrial adenocarcinoma patients with a prior malignancy from clinical trials except for the group that was diagnosed with endometrial adenocarcinoma within 1 year from the first cancer.Impact statementWhat is already known on this subject? Not enough evidence is found on the impact of prior malignancies on the survival of patients with subsequent endometrial adenocarcinoma.What do the results of this study add? History of a prior malignancy neither affects the overall survival of stage IV endometrial adenocarcinoma nor the cancer-specific survival. Only patients who had their second malignancy diagnosed within one year of the first malignancy should be excluded from clinical trials, while patients diagnosed within one to five years of the first cancer should be encouraged to enrol in clinical trials as they have an enhanced survival than patients without a history of malignancy.What are the implications of these findings for clinical practice and/or further research? We recommend that future researchers should consider including the aforementioned group of patients in their trials to achieve more accurate results and in order not to strip the patients of potential therapeutic benefits of enrolling in clinical trials.

Impact of prior cancer on outcomes in nasopharyngeal carcinoma

Background

Prior cancer is a common exclusion criterion in nasopharyngeal carcinoma (NPC) trials. However, whether a prior cancer diagnosis affects trial outcomes is still unknown. We aimed to determine the impact of prior cancer on survival in NPC patients.

Methods

We identified patients diagnosed with NPC between 2004 and 2009 in the Surveillance, Epidemiology, and End Results (SEER) database. Variables were compared by chi-squared test and t-test as appropriate. Propensity score-adjusted Kaplan-Meier methods and Cox proportional hazard models were used to evaluate the impact of prior cancer on overall survival (OS).

Results

Among 3,131 eligible NPC patients, 349 (11.15%) patients had a history of prior cancer. The Kaplan-Meier curves did not show a statistically significantly different OS (P=0.19). Subgroup analyses stratified by timing of prior cancer and AJCC TNM stage of index cancer displayed the same tendency: prior cancer did not adversely affect OS compared to patients without prior cancer (P>0.05). Furthermore, in propensity score-adjusted COX models analysis, patients with prior cancer had the same/non-inferior OS [hazard ratio (HR) =1.12; 95% confidence interval, 0.88 to 1.42].

Conclusions

Among patients with NPC, prior cancer does not convey an adverse effect on clinical outcomes, regardless of the timing of prior cancer and AJCC TNM stage of index cancer. Broader inclusion trial criteria could be adopted in NPC patients with a history of prior cancer. However, further studies are still needed to confirm this conclusion.