1
|
Matsuo K, Vallejo A, Barakzai SK, Nusbaum DJ, Machida H, Ciccone MA, Roman LD. Secondary ovarian cancer after external beam radiotherapy for nonovarian pelvic malignancy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:461-467. [PMID: 36064632 DOI: 10.1016/j.ejso.2022.08.025] [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: 06/29/2022] [Accepted: 08/23/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To examine characteristics and survival of patients who developed secondary ovarian cancer after external beam radiotherapy (EBRT) for a prior nonovarian pelvic malignancy. METHODS This is a population-based retrospective cohort study, querying the Surveillance, Epidemiology, and End Result program from 1975 to 2016. 167,269 women who received EBRT for 7 malignancies (anus, rectum, bladder, cervix, uterus, vulva, or vagina) were examined to identify subsequent secondary ovarian cancer diagnosis after EBRT. Then, within the ovarian cancer cohort (n = 147,618), characteristics and survival of patients with secondary ovarian cancer after EBRT were compared to those with ovarian cancer who did not receive prior EBRT. RESULTS Following EBRT for a pelvic malignancy, 215 (1.3 per 1000) patients developed secondary ovarian cancer. Among those, the most frequent prior malignancy was cervical cancer (45.6%), followed by rectal cancer (20.9%). The median time from prior EBRT to secondary ovarian cancer was 8.8 years (interquartile range, 2.8-14.5). In multivariable analysis, patients with secondary ovarian cancer after EBRT were more likely to be older, and have a recent year of diagnosis, but less likely to have early-disease compared to ovarian cancer patients without prior EBRT (all, P < 0.05). In weighted model, patients with secondary ovarian cancer after EBRT had decreased overall survival compared to those with ovarian cancer without prior EBRT (5-year rates, 19.6% versus 39.9%, hazard ratio 1.62, 95% confidence interval 1.43-1.85). Similar association was observed in ages <70, ≥70, White, non-White, early-disease, and advanced-disease in sensitivity analyses. CONCLUSION Radiotherapy-related secondary ovarian cancer may be associated with decreased overall survival.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Syem K Barakzai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - David J Nusbaum
- Section of Urology, University of Chicago Medicine, Chicago, IL, USA
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Song P, Wu X, Yang L, Ma K, Liu Z, Zhou J, Chen J, Zhu Q, Dong Q. Second Malignant Tumors and Non-Tumor Causes of Death for Patients With Penile Cancer During Their Survivorship. Cancer Control 2022; 29:10732748221134789. [PMID: 36267038 PMCID: PMC9597479 DOI: 10.1177/10732748221134789] [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] [Indexed: 11/26/2022] Open
Abstract
Background The aim was to evaluate the causes of death for patients with localized, regional and metastatic penile cancer (PeCa) after diagnosis. Methods PeCa patients diagnosed during 2004-2018 in the Surveillance, Epidemiology, and End Results program database were identified. Causes of deaths including PeCa, second malignant tumors (SMTs) and non-tumor diseases were analyzed, as well as the standardized mortality ratio (SMR) of each cause. Results For localized PeCa, 800 of 2155 patients died during the follow-up. 24.9% of all deaths were due to PeCa. 18.0% and 57.1% deaths were due to SMTs and non-tumor causes. Main SMTs included cancers of lung and bronchus (n = 40) and skin (n = 11) with significantly increased SMRs of 1.71 (1.22-2.33) and 4.82 (2.41-8.63). Mortality risks of other SMTs were mostly similar with the general populations. Main causes of non-tumor diseases included diseases of heart [n = 172, SMR: 1.66 (1.42-1.93)], COPD and allied cond [n = 38, SMR: 1.63 (1.15-2.24)], and cerebrovascular diseases [n = 33, SMR: 1.71 (1.17-2.4)]. For regional PeCa, 679 of 1310 patients died including 43.5% PeCa, 14.8% SMTs and 26.6% non-tumor causes. The mortality risks of cancers from lung and bronchus [SMR: 2.41 (1.53-3.62)], skin [SMR: 6.41 (2.35-13.95)] and testis [SMR: 149.35 (18.09-539.5)] were significantly increased. Main non-tumor causes of death included diseases of heart [n = 71, SMR: 1.77 (1.38-2.23)], COPD and allied cond [n = 17, SMR: 1.85 (1.08-2.95)] and diabetes mellitus [n = 16, SMR: 3.62 (2.07-5.88)]. For distant diseases, 109 of 132 patients died including 76 (69.7%) died for PeCa itself, 24 (22.0%) died for SMTs and 9 (8.3%) died for non-tumor diseases. The majority of PeCa deaths (67.1%) and SMTs deaths (79.2%) occurred within 1 year after the diagnosis of PeCa. Conclusions We firstly analyzed the SMTs and non-tumor causes of death and morality risks of each cause for PeCa patients, which provided valuable information for PeCa patients on disease prevention and health care during their survivorship.
Collapse
Affiliation(s)
- Pan Song
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China,Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | - Xiaotian Wu
- The Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Luchen Yang
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Ma
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhenghuan Liu
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Zhou
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Junhao Chen
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Zhu
- Department of General Medical, Medical Affairs Division, West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, The Institution of Urology, West China Hospital of Sichuan University, Chengdu, China,Qiang Dong, Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu 610041, China.
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Huang K, Xu L, Jia M, Liu W, Wang S, Han J, Li Y, Song Q, Fu Z. Second primary malignancies in cervical cancer and endometrial cancer survivors: a population-based analysis. Aging (Albany NY) 2022; 14:3836-3855. [PMID: 35507749 PMCID: PMC9134942 DOI: 10.18632/aging.204047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/25/2022] [Indexed: 01/24/2023]
Abstract
Background: We evaluated the relative attribution and interactions of treatment and patient-related risk factors for second primary malignancies (SPMs) in cervical and endometrial cancer survivors. Methods: Stage I–III cervical and endometrial cancer survivors’ data from the Surveillance, Epidemiology, and End Results (SEER) registry between January 1988 and December 2015 were analyzed. The standardized incidence ratio (SIR), excess absolute risk (EAR), and corresponding 95% confidence interval (95% CI) values were calculated. Analyses were classified based on proxies of human papillomavirus (HPV), smoking, hormone, and radiotherapy (RT) status. Additive and multiplicative interactions were assessed. Results: Cervical cancer survivors had a higher risk for developing potentially HPV and smoking-related SPMs, especially in the RT group (SIRHPV = 3.7, 95% CI: 2.9–4.6; SIRsmoking = 3.2, 95% CI: 2.8–3.6). Second vaginal cancer patients had the highest SIR (23.8, 95% CI: 14.9–36.0). There were strong synergistic interactions between RT and the proxy of smoking (Pinteraction < 0.001), accounting for 36% of potentially smoking-related SPMs in cervical cancer survivors. Conclusions: RT, HPV, and smoking promote SPMs in cervical cancer to different extents. The SPM burden in cervical cancer survivors could be mostly attributed to smoking and RT and their interactions.
Collapse
Affiliation(s)
- Kejie Huang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Lijuan Xu
- Department of Health Management, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Mingfang Jia
- Department of Health Management, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Wenmin Liu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Shijie Wang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jianglong Han
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yanbo Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan 430060, China
| |
Collapse
|
5
|
Shen J, Zhou H, Liu J, Zhang Z, Fang W, Yang Y, Hong S, Xian W, Ma Y, Zhou T, Zhang Y, Zhao H, Huang Y, Zhang L. Incidence and risk factors of second primary cancer after the initial primary human papillomavirus related neoplasms. MedComm (Beijing) 2021; 1:400-409. [PMID: 34766131 PMCID: PMC8491207 DOI: 10.1002/mco2.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Comprehensive studies in second primary cancer (SPC) after the initial primary human papillomavirus (HPV)-related cancer still remain warranted. We aimed to analyze the incidence and risk factors of SPC after HPV-related cancer. We identified 86 790 patients diagnosed with initial primary HPV-related cancer between 1973 and 2010 in the SEER database. Standardized incidence ratio (SIR) and cumulative incidence were calculated to assess the risk of SPC after HPV-related cancer. The SIR of SPC after HPV-related cancer was 1.60 (95% confidence interval [CI], 1.55-1.65) for male and 1.25 (95% CI, 1.22-1.28) for female. SIR of second primary HPV-related cancer (7.39 [95% CI, 6.26-8.68] male and 4.35 [95% CI, 4.04-4.67] female) was significantly higher than that of HPV-unrelated cancer (1.54 [95% CI, 1.49-1.60] male and 1.16 [95% CI, 1.13-1.19] female). The 5-year cumulative incidence of SPC was 7.22% (95% CI, 6.89-7.55%) for male and 3.72% (95% CI, 3.58-3.88%) for female. Risk factors for SPC included being married and having initial primary cancer (IPC) diagnosed at earlier stage for both genders, and IPC diagnosed at older age as well as surgery performed for female. Patients diagnosed with HPV-related cancer are more likely to develop another primary cancer, compared with the age-specific reference population.
Collapse
Affiliation(s)
- Jiayi Shen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China.,Zhongshan School of Medicine Sun Yat-sen University Guangzhou China
| | - Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Jiaqing Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China.,Zhongshan School of Medicine Sun Yat-sen University Guangzhou China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Wei Xian
- Zhongshan School of Medicine Sun Yat-sen University Guangzhou China
| | - Yuxiang Ma
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Ting Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Hongyun Zhao
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine Guangzhou China
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Qian C, Liu H, Feng Y, Meng S, Wang D, Nie M, Xu M. Clinical characteristics and risk of second primary lung cancer after cervical cancer: A population-based study. PLoS One 2020; 15:e0231807. [PMID: 32756555 PMCID: PMC7406086 DOI: 10.1371/journal.pone.0231807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background Lung cancer is increasingly common as a second primary malignancy. However, the clinical characteristics of second primary non-small cell lung cancer after cervical cancer (CC-NSCLC) compared with first primary non-small cell lung cancer (NSCLC1) is unknown. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry between 1998 and 2010 was used to conduct a large population-based cohort analysis. The demographic and clinical characteristics, as well as prognostic data, were systematically analyzed. The overall survival (OS) in the two cohorts was further compared. The risk factors of second primary lung cancer in patients with cervical cancer were also analyzed. Results A total of 557 patients (3.52%) developed second primary lung cancer after cervical cancer, and 451 were eligible for inclusion in the final analyses. Compared with NSCLC1, patients with CC-NSCLC had a higher rate of squamous cell carcinoma (SCC) (36.59% vs 19.07%, P < 0.01). The median OS was longer for CC-NSCLC than for NSCLC1 before propensity score matching (PSM) (16 months vs. 13 months) but with no significant difference after PSM (16 months vs. 17 months). The high-risk factors for the development of cervical cancer to CC-NSCLC include age 50–79 years, black race [odds ratio (OR) 1.417; 95% confidence interval (CI) 1.095–1.834; P < 0.05], and history of radiotherapy (OR 1.392; 95% CI 1.053–1.841; P < 0.05). Conclusion Age 50–79 years, black race, and history of radiotherapy were independent risk factors for second primary lung cancer in patients with cervical cancer. Patients with CC-NSCLC had distinctive clinical characteristics and better prognosis compared with patients with NSCLC1.
Collapse
Affiliation(s)
- Chengyuan Qian
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Hong Liu
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Feng
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Shenglan Meng
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Dong Wang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Mao Nie
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail: (MN); (MX)
| | - Mingfang Xu
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
- * E-mail: (MN); (MX)
| |
Collapse
|
8
|
Lum C, Prenen H, Body A, Lam M, Segelov E. A 2020 update of anal cancer: the increasing problem in women and expanding treatment landscape. Expert Rev Gastroenterol Hepatol 2020; 14:665-680. [PMID: 32458709 DOI: 10.1080/17474124.2020.1775583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Anal cancer is a rare malignancy with increasing incidence, notably in women. This disease is highly associated with HPV infection and its incidence and mortality are currently rising. Most patients present with localized disease which has a high survival after definitive treatment with chemoradiation. For patients who develop metastatic disease or present with this de novo, survival is poor. AREAS COVERED This review provides a summary of current literature on anal cancer. With a focus on women, this includes current epidemiological trends, role of HPV, and the current and future treatment landscape, including HPV vaccination and immunotherapy. Screening currently focusses on HIV-positive men, missing most female cases. In curative disease, trials are investigating treatment de-intensification in good prognostic groups. Immunotherapy is showing early promise in the advanced disease setting. EXPERT OPINION Similar to cervical cancer, anal cancer is strongly associated with HPV, and therefore, broader implementation of screening programs may reduce its incidence. HPV vaccination is expected to reduce the development of (pre)malignant anal lesions. The emergence of biomarkers will assist patient treatment selection, allowing optimal balance of treatment efficacy and morbidity. It is hoped that new treatment approaches, including immunotherapy, will improve outcomes. International collaboration is needed.
Collapse
Affiliation(s)
- Caroline Lum
- Medical Oncology, Monash Medical Centre , Clayton, Australia
| | - Hans Prenen
- Medical Oncology, Monash Medical Centre , Clayton, Australia.,Oncology Department, University Hospital Antwerp , Antwerp, Belgium
| | - Amy Body
- Medical Oncology, Monash Medical Centre , Clayton, Australia
| | - Marissa Lam
- Medical Oncology, Monash Medical Centre , Clayton, Australia
| | - Eva Segelov
- Medical Oncology, Monash Medical Centre , Clayton, Australia.,School of Clinical Sciences, Monash University , Clayton, Australia
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Risk of second primary cancers in individuals diagnosed with index smoking- and non-smoking- related cancers. J Cancer Res Clin Oncol 2020; 146:1765-1779. [DOI: 10.1007/s00432-020-03232-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 02/07/2023]
|
11
|
Nasioutziki M, Chatzistamatiou K, Loufopoulos PD, Vavoulidis E, Tsampazis N, Pratilas GC, Liberis A, Karpa V, Parcharidis E, Daniilidis A, Spanos K, Dinas K. Cervical, anal and oral HPV detection and HPV type concordance among women referred for colposcopy. Infect Agent Cancer 2020; 15:22. [PMID: 32318115 PMCID: PMC7160926 DOI: 10.1186/s13027-020-00287-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Infection with human papillomaviruses (HPVs) can cause benign and malignant tumours in the anogenital tract and the oropharynx both in men and women. The aim of the presented study was to investigate cervical, anal, and oral HPV-detection rates among women referred to colposcopy for abnormal Cervical Cancer (CaCx) screening results and assess the concordance of HPV-types among these anatomical sites. METHODS Women referred to colposcopy at a single centre due to abnormal cytology, conducted for CaCx screening, were subjected to cervical Liquid-based Cytology (LBC) smear testing, anal and oral sampling. Routine colposcopy consisted in multiple biopsies and/or Endocervical Curettage (ECC). HPV-detection was performed by PCR genotyping in all three anatomical sites. In high-risk (hr) HPV-DNA positive samples either from anal canal or oral cavity, anal LBC cytology and anoscopy were performed, or oral cavity examination respectively. Descriptive statistics was used for the analysis of HPV-detection rates and phi-coefficient for the determination of HPV-positivity concordance between the anatomical sites. RESULTS Out of 118 referred women, hr. HPV-DNA was detected in 65 (55.1%), 64 (54.2%) and 3 (2.5%) at cervix, anal canal and oral cavity respectively while low-risk HPV-DNA was detected in 14 (11.9%) and 11 (9.3%) at cervix and anal canal respectively. The phi-coefficient for cervix/anal canal was 0.392 for HPV16, 0.658 for HPV31, 0.758 for HPV33, - 0.12 for HPV45, 0.415 for HPV52 and 0.473 for HPV58. All values were statistically significant (p < 0.001). CONCLUSIONS The results suggest that most HPV-types, high-risk and low-risk, detected in the cervix of women with prevalent cervical dysplasia, correlate with the ones detected in their anal canal. This particularly applies for the HPV-types included in the nonavalent HPV-vaccine (HPVs 6/11/16/18/31/33/45/52/58).
Collapse
Affiliation(s)
- Maria Nasioutziki
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kimon Chatzistamatiou
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis-Dimitrios Loufopoulos
- 1st Department of General Surgery, Anal & Colorectal Clinic, Papageorgiou General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Tsampazis
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George-Chrysostomos Pratilas
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Liberis
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Karpa
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evanggelos Parcharidis
- Stomatology Clinic, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Daniilidis
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Spanos
- 1st Department of General Surgery, Anal & Colorectal Clinic, Papageorgiou General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Obstetrics & Gynaecology Department, Molecular & Morphological Clinical Cytopathology Laboratory, Hippokration General Hospital, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
12
|
Holstead R, Rasul R, Golden A, Kamdar D, Ghaly M, Teckie S, Frank D, Fantasia J, Seetharamu N. Identifying patterns of failure and secondary primary malignancies in HPV-related oropharyngeal squamous cell carcinomas. Future Oncol 2020; 16:199-207. [PMID: 31967480 DOI: 10.2217/fon-2019-0673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To compare patterns and rates of recurrence in patients with oropharyngeal squamous cell carcinoma by human papilloma virus (HPV) status. Patients & methods: Retrospective chart review of 155 patients diagnosed with oropharyngeal squamous cell carcinoma between 2012 and 2014 at a single center. Results: Two-year recurrence-free survival was higher in patients with HPV-positive tumors compared with negative (85.2% [standard error = 0.03] versus 59.3% [standard error = 0.09]; p < .001) with the former proportionally less likely to have locoregional recurrence. HPV-positive patients had proportionally higher incidence of second primary malignancies outside of head, neck and lung compared with HPV-negative (74.2 vs 37.5%; p = 0.09). Conclusion: The differences in failure by HPV status indicates a need for modified surveillance guidelines. The differences in second primary malignancies patterns are interesting, warranting further evaluation in larger studies.
Collapse
Affiliation(s)
- Ryan Holstead
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| | - Rehana Rasul
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| | - Anne Golden
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| | - Dev Kamdar
- Departement of Otolaryngology, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11040
| | - Maged Ghaly
- Department of Radiation Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11042
| | - Sewit Teckie
- Department of Radiation Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11042
| | - Douglas Frank
- Departement of Otolaryngology, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11040
| | - John Fantasia
- Department of Dental Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11040
| | - Nagashree Seetharamu
- Department of Medicine, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, NY USA, 11030
| |
Collapse
|
13
|
Makhmudov DE, Kolesnik OO, Lagoda NN, Volk MO. Leiomyosarcoma of the Rectum as a Radiation-Induced Second Malignancy after Cervical Cancer Treatment: Case Report with Review of the Literature. Case Rep Oncol Med 2019; 2019:1610653. [PMID: 31885968 PMCID: PMC6925813 DOI: 10.1155/2019/1610653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Incidence of cervical cancer among women of reproductive age still remains significantly high. In regard to prognostic features and risk factors, the standard treatment for most types of cervical cancer represents a combination of surgical treatment and radiation therapy, such as external beam radiation therapy and brachytherapy. Despite significant advances of long-term oncological outcomes, radiation-induced secondary malignancies among cervical cancer survivors are still an issue. Current case report describes an incredibly rare case of radiation-induced leiomyosarcoma of the rectum, which occurred 32 years after cervical cancer treatment. CASE PRESENTATION A 62-year-old female had a past medical history of FIGO stage IIB cervical cancer (squamous cell carcinoma pT2bN0M0). In 1987, she underwent radical hysterectomy with bilateral iliac lymph node dissection, followed by adjuvant radiation therapy-70 Gy external beam pelvic irradiation followed by 30.5 Gy of brachytherapy. Thirty-two years later, she presented with signs of rectal bleeding. Regarding past medical history, radiologic, endoscopic, and pathologic data, the patient was initially diagnosed with a malignant nonepithelial lower rectal tumor of the unknown origin and staged as mrT3a mrN0 cM0. Total mesorectal excision with complete mesocolic excision and central vascular ligation (CME/CVL) carried by an open approach was carried out. In an attempt to identify the tissue of origin, an immunohistochemistry assay had been performed. Tumor cells showed a high rate of mitotic activity with a 45% rate of Ki-67 expression, positive reaction for desmin, and SMA in all samples. Negative reaction for CD117 and S100 was observed. As a conclusion, the immunophenotype was identified as a grade 3 leiomyosarcoma (ISD-code 8890/3). CONCLUSIONS We suggest that up to date, radical surgery with curative intent, as it was performed in our study, is the most evidence-based treatment option for patients with radiation-induced sarcomas of the rectum.
Collapse
Affiliation(s)
- Dmytro E. Makhmudov
- Oncocoloproctology Department, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| | - Olena O. Kolesnik
- Oncocoloproctology Department, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| | - Natalia N. Lagoda
- Department of Pathomorphology, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| | - Maryna O. Volk
- Oncocoloproctology Department, National Cancer Institute, Lomonosova str. 33/43, Kyiv 03022, Ukraine
| |
Collapse
|
14
|
Wang M, Sharma A, Osazuwa-Peters N, Simpson MC, Schootman M, Piccirillo JF, Huh WK, Adjei Boakye E. Risk of subsequent malignant neoplasms after an index potentially-human papillomavirus (HPV)-associated cancers. Cancer Epidemiol 2019; 64:101649. [PMID: 31816512 DOI: 10.1016/j.canep.2019.101649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Since the number of cancer survivors is increasing, it is imperative that we better understand the long-term consequences of these survivors. We assessed the risk of developing a second primary malignant neoplasm (SPMN) after an index potentially-HPV-associated cancers (P-HPV-AC). METHODS We constructed a population-based cohort of patients with P-HPV-AC using Surveillance, Epidemiology, and End Results registry data (2000-2015). We limited patients to those with invasive P-HPV-AC [cervical, vagina, vulva, penile, anal, and oropharynx] based on the International Classification of Diseases for Oncology, 3rd edition. Excess SPMN risks were calculated based on standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). RESULTS A total of 105,644 patients with an index P-HPV-AC were identified, and 7.8 % developed a SPMN. In all P-HPV-AC patients, the overall SIR was 1.73 (95 % CI: 1.69-1.77) and EAR of 70.72 per 10,000 PYR. All index P-HPV-AC sites showed statistically significant increases in the risk of SPMN, except for anal cancer among men, compared with the general population. The greatest increase in risk of SPMN was observed among patients diagnosed with an index P-HPV-oropharyngeal cancer (SIR = 1.83; 95 % CI, 1.70-1.82 and SIR = 2.29; 95 % CI, 2.12-2.47 for men and women, respectively). Men developed SPMN mostly in aero-digestive tract whiles women developed SPMN both in aero-digestive tract and other HPV-associated cancer sites. CONCLUSIONS P-HPV-AC survivors experienced excess risk of SPMN. These findings have the potential to affect future surveillance practices and improve preventive healthcare for survivors of P-HPV-ACs.
Collapse
Affiliation(s)
- Maggie Wang
- Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA.
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, 720 N. Bond Street, Springfield, IL 62702, USA.
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3660 Vista Ave, St. Louis, MO 63110, USA; Saint Louis University Cancer Center, 3685 Vista Ave, St. Louis, MO 63110, USA.
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3660 Vista Ave, St. Louis, MO 63110, USA.
| | - Mario Schootman
- Center for Clinical Excellence, SSM Health, 10101 Woodfield Ln., St. Louis, MO 63132, USA.
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, USA.
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, P. O. Box 19664, Springfield, IL 62794-9664, USA; Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge St, Springfield, IL 62702, USA; Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, 315 W Carpenter St, Springfield, IL 62702, USA.
| |
Collapse
|
15
|
Zhang L, Hemminki O, Chen T, Zheng G, Försti A, Sundquist K, Sundquist J, Hemminki K. Familial Clustering, Second Primary Cancers and Causes of Death in Penile, Vulvar and Vaginal Cancers. Sci Rep 2019; 9:11804. [PMID: 31413311 PMCID: PMC6694134 DOI: 10.1038/s41598-019-48399-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/02/2019] [Indexed: 12/19/2022] Open
Abstract
Data on familial risks in penile and vulvar/vaginal cancers and in second primary cancers (SPCs) following these cancers are limited. We used the Swedish Family-Cancer Database from years 1958 through 2015 to identify 3641 penile and 8856 vulvar/vaginal cancers and to calculate relative risks (RRs) and 95% confidence intervals (CIs) for these cancers according to site-specific cancer in family members; additionally risk for SPCs was calculated. The familial RR for concordant (same) penile cancer was 3.22 (1.34-7.74), and it was 2.72 (1.69-4.39) for vulvar/vaginal cancer; RRs were increased for vulvar/vaginal cancer in families of anal cancer patients. RR for second penile cancer after penile cancers was 11.68 (7.95-17.18), while that for concordant vulvar/vaginal cancer was 9.03 (7.31-11.15). SPCs were diagnosed in 16.8% of penile cancer patients and in them 45.9% of deaths were caused by SPC (other than penile cancer). In vulvar/vaginal cancer patients with SPC, 36.4% of deaths were due to SPC. The results showed that these genital cancers might run in families and as SPCs are associated with human papilloma virus and smoking related cancers. Risk for these genital and anal SPCs are high and a follow-up plan should be agreed at diagnosis of these cancers.
Collapse
Affiliation(s)
- Luyao Zhang
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Otto Hemminki
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
- Cancer Gene Therapy Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tianhui Chen
- Group of Molecular Epidemiology and Cancer Precision Prevention, Zhejiang Academy of Medical Sciences (ZJAMS), Hangzhou, China
| | - Guoqiao Zheng
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
- Group of Molecular Epidemiology and Cancer Precision Prevention, Zhejiang Academy of Medical Sciences (ZJAMS), Hangzhou, China.
| |
Collapse
|
16
|
Lin C, Slama J, Gonzalez P, Goodman MT, Xia N, Kreimer AR, Wu T, Hessol NA, Shvetsov Y, Ortiz AP, Grinsztejn B, Moscicki AB, Heard I, Del Refugio González Losa M, Kojic EM, Schim van der Loeff MF, Wei F, Longatto-Filho A, Mbulawa ZA, Palefsky JM, Sohn AH, Hernandez BY, Robison K, Simpson S, Conley LJ, de Pokomandy A, van der Sande MAB, Dube Mandishora RS, Volpini LPB, Pierangeli A, Romero B, Wilkin T, Franceschi S, Hidalgo-Tenorio C, Ramautarsing RA, Park IU, Tso FK, Godbole S, D'Hauwers KWM, Sehnal B, Menezes LJ, Heráclio SA, Clifford GM. Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis. THE LANCET. INFECTIOUS DISEASES 2019; 19:880-891. [PMID: 31204304 PMCID: PMC6656696 DOI: 10.1016/s1473-3099(19)30164-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer. METHODS We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL. FINDINGS Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16·5, 95% CI 14·2-19·2, p<0·0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4·4, 3·7-5·3, p<0·0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14·1, 11·1-17·9, p<0·0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12·9, 95% CI 6·7-24·8, p<0·0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2·3, 1·6-3·4, p<0·0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23·1, 9·4-57·0, p<0·0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3·6, 2·5-5·3, p<0·0001). Prevalence of HPV16-positive anal HSIL was 23-25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women). INTERPRETATION HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women. FUNDING International Agency for Research on Cancer.
Collapse
Affiliation(s)
- Chunqing Lin
- International Agency for Research on Cancer, Lyon, France; National Cancer Center, National Clinical Research Center for Cancer, and Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiri Slama
- Department of Gynecology and Obstetrics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Paula Gonzalez
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | - Marc T Goodman
- Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Aimée R Kreimer
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ting Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | | | - Yurii Shvetsov
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Ana P Ortiz
- University of Puerto Rico Comprehensive Cancer Center, Department of Biostatistics and Epidemiology, Graduate School of Public Health, UPR, San Juan, Puerto Rico
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | | | - Isabelle Heard
- Department of Endocrinology and Reproductive Medicine, IE3M, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris, Paris, France
| | | | - Erna M Kojic
- Mount Sinai West and St Luke's Hospitals, New York, NY, USA
| | | | - Feixue Wei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Adhemar Longatto-Filho
- Research Institute of Life and Health Sciences, School of Medicine, University of Minho, Braga, Portugal; 3B's (Biomaterials, Biodegradables and Biomimetics) Research Group, Portugal Government Associate Laboratory, Braga, Portugal; Laboratory of Medical Investigation 14, Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; Teaching and Research Institute, Molecular Oncology Research Center, Barretos Cancer Hospital-Pio XII Foundation, Barretos, Brazil
| | - Zizipho A Mbulawa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa; Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; South African Medical Research Council Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | | | - Annette H Sohn
- TREAT Asia/amfAR-Foundation for AIDS Research, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | - Katina Robison
- Obstetrics & Gynecology and Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Steve Simpson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lois J Conley
- Division of HIV/AIDS Prevention, Epidemiology Research Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexandra de Pokomandy
- Chronic Viral Illness Service, McGill University Health Centre and Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Marianne A B van der Sande
- Public Health Epidemiology, Head Department Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Racheal S Dube Mandishora
- Department of Medical Microbiology, University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital premises, Harare, Zimbabwe
| | - Lays P B Volpini
- Health Sciences Center, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Byron Romero
- Proyecto Epidemiológico Guanacaste, Fundación INCIENSA, San José, Costa Rica
| | | | | | | | | | - Ina U Park
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Fernanda K Tso
- Department of Gynecology of the Federal University of São Paulo, São Paulo, Brazil
| | - Sheela Godbole
- Division of Epidemiology and Biostatistics, ICMR-National AIDS Research Institute, Indian Council of Medical Research, Pune, India
| | - Kathleen W M D'Hauwers
- Radboud University Nijmegen, Medical Centre, Department of Urology, Nijmegen, Netherlands
| | - Borek Sehnal
- Department of Gynecology and Obstetrics, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lynette J Menezes
- Division of Infectious Disease, University of South Florida, Tampa, FL, USA
| | - Sandra A Heráclio
- Women's Healthcare Center, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Cytopathology Division, Public Health Laboratory of the State of Pernambuco, Recife, PE, Brazil
| | | |
Collapse
|
17
|
Li Z, Wang K, Shi Y, Zhang X, Wen J. Incidence of second primary malignancy after breast cancer and related risk factors-Is breast-conserving surgery safe? A nested case-control study. Int J Cancer 2019; 146:352-362. [PMID: 30861567 DOI: 10.1002/ijc.32259] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 02/05/2023]
Abstract
Risk of second primary malignancy (SPM) is increasing. We aimed to assess the incidence and related risk factors of SPM among breast cancer (BC) patients from this nested case-control study using the SEER database. BC patients with SPM were identified as the case group and SPM-free patients were defined as the control group. Propensity score matching of cases with controls by the year of the first primary BC diagnosis was conducted at the ratio of 1:5, and 97,242 BC patients were enrolled from 1998 to 2013 after the matching. The incidence of SPM in BC patients stratified by age groups and cancer sites was compared to the general population using the adjusted standardized incidence ratio (SIR) and the risk factors for SPM were examined using Cox proportional hazard regressions. Our study showed BC patients had excess risk for SPM than the general population (adjusted SIR for all cancer sites = 12.94, p < 0.001) and the incidence of SPM among them decreased with age. The risk of SPM was significantly related to the following demographical and clinical variables: age (40-59 vs. 18-39, HR = 1.33; 60-79 vs. 18-39, HR = 2.39; ≥80 vs. 18-39, HR = 2.84), race (black vs. white, HR = 1.12), histological type (lobular BC vs. ductal BC, HR = 1.15), radiotherapy (HR = 1.33), marital status (married vs. single, HR = 0.88) and estrogen receptor status (positive vs. negative, HR = 0.85). Consistent results were found in subgroup analysis stratified by contralateral-breast SPMs and nonbreast SPMs.
Collapse
Affiliation(s)
- Zhuyue Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China.,West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Kang Wang
- Department of the Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Yang Shi
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Xuemei Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
18
|
Next generation sequencing driven successful combined treatment with laparoscopic surgery and immunotherapy for relapsed stage IVB cervical and synchronous stage IV lung cancer. Oncotarget 2019; 10:2012-2021. [PMID: 31007844 PMCID: PMC6459345 DOI: 10.18632/oncotarget.26769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/22/2019] [Indexed: 01/22/2023] Open
Abstract
Background: The treatment of patients with multiple synchronous tumors is challenging and complex. The use of next generation sequencing (NGS) may help in identification of germline mutations in genes involved in a common etiology for both tumors thus allowing a common effective therapeutic strategy. Patients and Methods: We describe the unexpected positive results obtained in a young woman with relapsed chemo-resistant stage IVB cervical and synchronous stage IV lung cancer, who underwent an interdisciplinary approach including palliative surgery with laparoscopic total pelvic exenteratio followed by a chemo-immunotherapy protocol with the anti-Programmed Death (PD)-1 antibody nivolumab plus metronomic cyclophosphamide. The treatment choice was based on tumor PD-Ligand 1 assessment and NGS analysis for the identification of potential treatment targets. Outcomes included tumor objective response and patient-centered outcomes (pain, performance status and overall quality of life). Results: Laparoscopic surgery obtained an immediate symptom control and allowed the early start of medical treatment. One month after combined therapy start the patient achieved a significant improvement in performance status, pain, overall Quality of life and after 3 months she resumed working. After 3 and 6 months of treatment we observed an objective dimensional and metabolic response. Currently, after 24 months (and 48 cycles of nivolumab) the patient is continuing to benefit from treatment: she is in complete remission, with good performance status and she is working and leading a self-dependent life. Conclusion: Our study strongly affirms the efficacy of an interdisciplinary approach including surgical and innovative medical strategies based on immunotherapy in patients with advanced chemo-resistant synchronous cervical and lung cancer. The present findings support the use of NGS to drive a targeted rational treatment especially in heavily pre-treated patients.
Collapse
|
19
|
Risk of Anal Cancer in Women With a Human Papillomavirus-Related Gynecological Neoplasm: Puerto Rico 1987-2013. J Low Genit Tract Dis 2018; 22:225-230. [PMID: 29649025 DOI: 10.1097/lgt.0000000000000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the magnitude of the association between HPV-related gynecological neoplasms and secondary anal cancer among women in Puerto Rico (PR). MATERIALS AND METHODS We identified 9,489 women who had been diagnosed with a primary cervical, vaginal, or vulvar tumor during 1987-2013. To describe the trends of invasive cervical, vulvar, vaginal, and anal cancer, the age-adjusted incidence rates were estimated using the direct method (2000 US as Standard Population). Standardized incidence ratios (observed/expected) were computed using the indirect method; expected cases were calculated using 2 methods based on age-specific rates of anal cancer in PR. The ratio of standardized incidence ratios of anal cancer was estimated using the Poisson regression model to estimate the magnitude of the association between HPV-gynecologic neoplasms and secondary anal cancer. RESULTS A significant increase in the incidence trend for anal cancer was observed from 1987 to 2013 (annual percent change = 1.1, p < .05), whereas from 2004 to 2013, an increase was observed for cervical cancer incidence (annual percent change = 3.3, p < .05). The risk of secondary anal cancer among women with HPV-related gynecological cancers was approximately 3 times this risk among women with non-HPV-related gynecological cancers (relative risk = 3.27, 95% CI = 1.37 to 7.79). CONCLUSIONS Anal cancer is increasing among women in PR. Women with gynecological HPV-related tumors are at higher risk of secondary anal cancer as compared with women from the general population and with those with non-HPV-related gynecological cancers. Appropriate anal cancer screening guidelines for high-risk populations are needed, including women with HPV-related gynecological malignancies and potentially other cancer survivors.
Collapse
|
20
|
Matsuo K, Machida H, Mandelbaum RS, Ragab OM, Roman LD, Wright JD. Tumor-specific outcome of metachronous uterine malignancy after pelvic irradiation for cervical cancer. Gynecol Oncol 2018; 151:250-256. [PMID: 30197062 DOI: 10.1016/j.ygyno.2018.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine survival of women who develop metachronous uterine malignancy after definitive pelvic radiotherapy for cervical cancer. METHODS This retrospective observational study examined the Surveillance, Epidemiology, End Results Program between 1973 and 2013. Women with cervical cancer who received definitive radiotherapy without hysterectomy were examined for the diagnosis of metachronous uterine malignancy (n = 5277). Survival was compared between metachronous and non-metachronous uterine malignancies according to tumor factors. RESULTS The 10- and 20-year cumulative incidences of metachronous uterine malignancy were 0.6% and 1.2%, respectively. When compared to non-metachronous uterine malignancy, metachronous tumor were more likely to be non-endometrioid and advanced-stage (both, P < 0.001). As a whole cohort, metachronous uterine malignancy was significantly associated with decreased overall survival (OS) compared to non-metachronous tumors (hazard ratio [HR] 4.22, P < 0.001). OS was significantly worse in metachronous compared to non-metachronous malignancies, although the magnitude of statistical significance was greater for endometrioid tumors (HRs for endometrioid versus non-endometrioid: 6.17 versus 1.92). For grade 1-2 endometrial cancer, metachronous cases had significantly decreased OS compared to non-metachronous cases, a larger difference than that seen in higher grade tumors (HRs for grade 1-2 versus 3: 7.79 versus 2.15). Similarly, in early-stage endometrial cancer, metachronous cases had significantly decreased OS, with a greater HR compared to advanced-stage disease (HRs for stage I-II versus III-IV: 5.29 versus 2.29). CONCLUSION Radiotherapy-associated metachronous uterine malignancy after cervical cancer is rare but commonly presents with aggressive tumor characteristics. The impact on survival is considerably high when metachronous uterine malignancy is endometrioid, low-grade, and early-stage.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Hiroko Machida
- Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Omar M Ragab
- Division of Radiation Oncology, Department of Radiology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
21
|
Mahfoud T, Tanz R, Khmamouche RM, El Hammoumi MM, Allaoui M, Belbaraka R, Ichou M. Triple malignancy in a single patient including a squamous cell carcinoma of the cervix, a colloid adenocarcinoma of the colon and a lung adenocarcinoma: A case report and literature review. Int J Surg Case Rep 2018; 41:465-468. [PMID: 29546018 PMCID: PMC5709303 DOI: 10.1016/j.ijscr.2017.11.013] [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: 09/21/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022] Open
Abstract
Triple malignancy in the same patient is exceptional. The etiology remains controversial. The management depend on stages. Surgery is the standard of care in localized cancers.
Introduction The association of two cancers in the same patient is unusual but has been widely reported in the literature, while triple malignancy in the same patient is exceptional. Indeed, only very rare cases have been described. Case presentation A 70-year-old woman treated in our institute in 2006 for a tumor of the cervix. She underwent extrafascial hysterectomy. Pathology revealed a well differentiated squamous cell carcinoma of the cervix (pT1N0M0). No external pelvic radiation or brachytherapy were done. The patient remained in good control until 2013 when she presented a tumor of the ascending colon. A right hemicolectomy was made. Pathology confirmed a colloid adenocarcinoma (pT3N0M0). No adjuvant chemotherapy was given. Three years later, a Computed tomography scan of the chest revealed a nodule of the lower lobe of the left lung. Biopsy was made. Histology with immunochemistry revealed the diagnosis of lung adenocarcinoma. Positron emission tomography scan showed abnormal fluorodeoxyglucose uptake in the lung nodule with no anomaly in mediastinal nodes and no metastasis. A left lower lobectomy was performed with lymph node dissection. Pathology confirmed the diagnosis of 2.5 cm lung adenocarcinoma without node invasion (pT1N0M0). No chemotherapy was given. After 14 months, the patient remained in good control. Conclusions Triple malignancy in a single patient is exceptional. The management depend on stages. Surgery is the standard of care in localized cancers.
Collapse
Affiliation(s)
- Tarik Mahfoud
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco; Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
| | - Rachid Tanz
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Réda M Khmamouche
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Massine M El Hammoumi
- Department of Thoracic Surgery, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Mohamed Allaoui
- Department of Pathology, Mohamed V Military University Hospital, Rabat, Morocco.
| | - Rhizlane Belbaraka
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco; Oncology and Hematology Center, Mohammed IV University Hospital, Marrakech, Morocco.
| | - Mohamed Ichou
- Department of Medical Oncology, Mohamed V Military University Hospital, Rabat, Morocco.
| |
Collapse
|
22
|
Wakayama A, Kudaka W, Nakasone T, Taira Y, Aoki Y. Secondary uterine carcinosarcoma after concurrent chemoradiotherapy for cervical cancer: Case reports. Gynecol Oncol Rep 2017; 21:81-83. [PMID: 28761924 PMCID: PMC5524167 DOI: 10.1016/j.gore.2017.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/08/2017] [Accepted: 07/16/2017] [Indexed: 11/29/2022] Open
Abstract
Secondary uterine sarcomas occur in < 1% of patients treated with CCRT. Secondary uterine sarcomas can occur > 5 years from CCRT. The median survival period from the secondary tumor occurrence was only 4 months. All our patients had heterologous carcinosarcoma of the uterine corpus.
Collapse
Affiliation(s)
- Akihiko Wakayama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Wataru Kudaka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tadaharu Nakasone
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Taira
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoichi Aoki
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
23
|
Lin SM, Ku HY, Chang TC, Liu TW, Hong JH. The prognostic impact of overall treatment time on disease outcome in uterine cervical cancer patients treated primarily with concomitant chemoradiotherapy: a nationwide Taiwanese cohort study. Oncotarget 2017; 8:85203-85213. [PMID: 29156713 PMCID: PMC5689603 DOI: 10.18632/oncotarget.19617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/06/2017] [Indexed: 11/25/2022] Open
Abstract
The importance of the overall treatment time (OTT) has a paradoxical status in the current era of concomitant chemoradiotherapy. The main objective of this nationwide study was to evaluate the correlation between overall treatment duration and clinical outcome in cervical cancer patients treated primarily with curative concurrent chemoradiotherapy (CCRT). In this population-based cohort study, 2,594 patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA uterine cervical cancer were studied. Univariate and multivariate analyses of prognostic factors were analyzed using Cox’s proportional hazards models. The median irradiation duration was 59 days. Significant prognostic factors related to poor cancer-specific survival (CSS) and overall survival (OS) included old age, non-squamous cell cancer type, high-grade histology, increased tumor size, advanced FIGO stage, and prolonged OTT. After multivariate analysis, prolonged treatment time remained as a significant factor for poor CSS (hazard ratio, HR = 1.33; p < 0.001) and OS (HR = 1.15; p = 0.05). Further subgroup analysis showed that the 5-year OS rates after a treatment time of ≤ 56 days compared with > 56 days in patients with FIGO stages I-IIB and III-IVA were 70% and 65% (p = 0.002) compared with 43% and 42% (p = 0.67), respectively. Inconclusion, completion of CCRT within 8 weeks is recommended, particularly for patients with FIGO stage I-IIB disease.
Collapse
Affiliation(s)
- Shih-Min Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiu-Ying Ku
- National Health Research Institute, Miaoli, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsang-Wu Liu
- National Health Research Institute, Miaoli, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
24
|
Zullo A, Balsamo G, Lorenzetti R, Romiti A, De Francesco V, Hassan C, Manta R. Gastric metastases from gynaecologic tumors: case reports and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:483. [PMID: 28149845 DOI: 10.21037/atm.2016.12.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The stomach is an infrequent localization of tumor metastases, and metastases originating from primary gynaecological cancers are particularly rare. We described the case of three females with ovarian, uterine, and breast metastases in the stomach, and we performed a systematic review of the literature of cases diagnosed at endoscopy. Overall, data of 18 patients with gastric metastases originating from the ovary, 11 from the uterus, and 159 from breast cancer were analyzed. Therefore, gastric metastasis mainly occurs from breast cancer, whilst both ovarian and uterine metastases are distinctly less frequent, but not impossible.
Collapse
Affiliation(s)
- Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | | | - Adriana Romiti
- Oncology Unit, Sant'Andrea University Hospital, Rome, Italy
| | | | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Raffaele Manta
- Gastroenterology Unit, Nuovo Ospedale Civile Sant'Agostino-Estense, Baggiovara-Modena, Italy
| |
Collapse
|
25
|
Chiou WY, Chen CA, Lee MS, Lin HY, Li CY, Su YC, Tsai SJ, Hung SK. Pelvic inflammatory disease increases the risk of a second primary malignancy in patients with cervical cancer treated by surgery alone. Medicine (Baltimore) 2016; 95:e5409. [PMID: 27893679 PMCID: PMC5134872 DOI: 10.1097/md.0000000000005409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
As the number of long-term cervical cancer survivors continues to increase because of improvements in treatment, concerns about second primary malignancy have grown. The high-risk area of second primary cancers in cervical cancer survivors is the pelvis. Pelvic inflammatory disease (PID) could be a useful marker for gynecological cancers. Thus, we designed a large-scale, nationwide, controlled cohort study to investigate whether PID or other risk factors increased the risk of second primary cancers in patients with cervical cancer treated by surgery alone.Between 2000 and 2010, a total of 24,444 cervical cancer patients were identified using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan. Patients who received definite surgery were selected. To exclude the effect on second primary malignancy by treatment modalities, all cervical patients who ever having received adjuvant or definite radiotherapy or chemotherapy for primary cervical cancer were excluded. Finally, 3860 cervical cancer patients treated by surgery alone without adjuvant treatments were analyzed.Cox proportional hazards model was used for multivariate analysis and the Kaplan-Meier method was used to assess the cumulative risks. Regarding the incidence of second primary cancers, the standardized incidence ratio (SIR) was used.The median follow-up time was 56.6 months. The 6-year cumulative risk of second primary cancers is 0.16% and 0.12% for PID and without PID, respectively. After adjustment for confounders, age of less than 50 years, the presence of diabetes mellitus, and PID were significantly positivity associated with the risk of second primary cancers. The hazard ratios (HRs) of age less than 50 years, diabetes mellitus, and PID were 1.38 (95% CI = 1.11-2.04), 1.40 (95% CI = 1.06-1.85), and 1.35 (95% CI = 1.00-1.81), respectively. A higher incidence of second primary cancers was observed in the genitals, bladder, and colon.In conclusion, the incidence of second primary cancers was higher in the genitals, bladder, and colon in patients with cervical cancer treated with surgery alone. The patients with PID had a higher risk of second primary cancers.
Collapse
Affiliation(s)
- Wen-Yen Chiou
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualian
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan
| | - Chien-An Chen
- Department of Radiation Oncology, Zhongxing Branch, Taipei City Hospital, Taipei
| | - Moon-Sing Lee
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualian
| | - Hon-Yi Lin
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualian
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan
- Department of Public Health, China Medical University, Taichung
| | - Yu-Chieh Su
- Division of Hematology and Oncology, E-Da Hospital, Kaohsiung
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shiang-Jiun Tsai
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Shih-Kai Hung
- Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualian
| |
Collapse
|
26
|
Lee B, Ahn SH, Kim H, Son J, Sung J, Han Y, Huh SJ, Kim JS, Kim DW, Yoon M. Secondary cancer-incidence risk estimates for external radiotherapy and high-dose-rate brachytherapy in cervical cancer: phantom study. J Appl Clin Med Phys 2016; 17:124-132. [PMID: 27685104 PMCID: PMC5874128 DOI: 10.1120/jacmp.v17i5.6087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/25/2016] [Accepted: 04/24/2016] [Indexed: 02/04/2023] Open
Abstract
This study was designed to estimate radiation‐induced secondary cancer risks from high‐dose‐rate (HDR) brachytherapy and external radiotherapy for patients with cervical cancer based on measurements of doses absorbed by various organs. Organ doses from HDR brachytherapy and external radiotherapy were measured using glass rod dosimeters. Doses to out‐of‐field organs were measured at various locations inside an anthropomorphic phantom. Brachytherapy‐associated organ doses were measured using a specialized phantom that enabled applicator insertion, with the pelvis portion of the existing anthropomorphic phantom replaced by this new phantom. Measured organ doses were used to calculate secondary cancer risk based on Biological Effects of Ionizing Radiation (BEIR) VII models. In both treatment modalities, organ doses per prescribed dose (PD) mostly depended on the distance between organs. The locations showing the highest and lowest doses were the right kidney (external radiotherapy: 215.2 mGy; brachytherapy: 655.17 mGy) and the brain (external radiotherapy: 15.82 mGy; brachytherapy: 2.49 mGy), respectively. Organ doses to nearby regions were higher for brachytherapy than for external beam therapy, whereas organ doses to distant regions were higher for external beam therapy. Organ doses to distant treatment regions in external radiotherapy were due primarily to out‐of‐field radiation resulting from scattering and leakage in the gantry head. For brachytherapy, the highest estimated lifetime attributable risk per 100,000 population was to the stomach (88.6), whereas the lowest risks were to the brain (0.4) and eye (0.4); for external radiotherapy, the highest and lowest risks were to the thyroid (305.1) and brain (2.4). These results may help provide a database on the impact of radiotherapy‐induced secondary cancer incidence during cervical cancer treatment, as well as suggest further research on strategies to counteract the risks of radiotherapy‐associated secondary malignancies. PACS number(s): 87.52.‐g, 87.52.Px, 87.53.Dq, 87.53.Jw
Collapse
Affiliation(s)
- Boram Lee
- Korea University; Samsung Medical Center.
| | | | | | | | | | | | | | | | | | | |
Collapse
|