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Du J, Bao Z, Liang T, Zhao H, Zhao J, Xu R, Wang X. Risk factors for metachronous esophageal squamous cell carcinoma after endoscopic or surgical resection of esophageal carcinoma: a systematic review and meta-analysis. Front Oncol 2023; 13:1241572. [PMID: 37781208 PMCID: PMC10540085 DOI: 10.3389/fonc.2023.1241572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background early-stage esophageal carcinoma (EC) patients lack typical clinical signs and symptoms and are often diagnosed and treated at a late stage, leading to a poor prognosis and a high incidence of metachronous esophageal squamous cell carcinoma (MESCC) and second primary carcinoma (SPC). The aims of the review were to identify and quantify risk factors for MESCC and analysis location of SPC in postoperative patients with EC; to predict incidence of MESCC over follow-up time. Methods an electronic search of studies reporting potential risk factors, the incidence of MESCC, and the location of SPC were performed on PubMed, Web of Science, Cochrane Library, Embase, and Scopus from inception to 10 November 2022. The Newcastle-Ottawa scale was used to assess the study quality, and the qualitative strength of evidence rating of all items was provided. The meta-regression model was used to predict the incidence of MESCC over follow-up time, the location distribution of SPC was presented using clustered column chart, while the publication bias was assessed using funnel plots and Egger's test. Results smoking, age, history of multiple other cancer, and Lugol-voiding lesions (LVLs) were determined to be the risk factors of MESCC. LVLs were qualitatively determined as "definite" and the history of multiple other cancer as "likely." The overall pooled MESCC incidence was 20.3% (95% CI: 13.8% to 26.8%), with an increase of 0.20% for each additional year of follow-up. The head and neck were the most common locations for SPC, followed by the esophagus. Conclusion timely investigating the age of patients, previous history of cancer and monitoring the number of LVLs in the first 5 years after operation are of great significance to identify high-risk populations of MESCC for timely medical care. Education and behavior correction about smoking are advocated. Tumor markers should be regularly detected in the head and neck, esophagus, and stomach. Endoscopic resection was associated with a higher incidence of MESCC, which provided a reference for doctors to choose the removal method. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022377030.
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Affiliation(s)
- Jie Du
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Zhixian Bao
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, China
- Key Laboratory for Gastrointestinal Diseases of Gansu Province, The First Hospital of Lanzhou University, Lanzhou, China
| | - Tianhu Liang
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Hongmei Zhao
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Junxian Zhao
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ruipu Xu
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
- Talent Service Center, Gansu Provincial Health Commission, Lanzhou, China
| | - Xiaohui Wang
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
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Effect of prior thyroid cancer on survival of primary liver cancer: a study based on the SEER database. Sci Rep 2022; 12:13887. [PMID: 35974063 PMCID: PMC9381514 DOI: 10.1038/s41598-022-17729-4] [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: 03/08/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022] Open
Abstract
To explore the effect of prior thyroid cancer on the survival of primary liver cancer (PLC). Eligible PLC patients were selected from the Surveillance, Epidemiology, and End Results (SEER) database during 2004-2016. Propensity score matching (PSM) was used to create a highly comparable control group that PLC patients without prior thyroid cancer. All PLC patients were divided into three groups based on the survival information: (1) PLC-specific death; (2) death due to other causes; (3) alive. The effect sizes were presented by the corresponding hazard ratio (HR) and 95% confidence intervals (CI). Totally, 142 PLC patients with prior thyroid cancer and 1420 PLC patients without prior thyroid cancer were included. During the follow-up period, 714 (45.71%) PLC patients died of liver cancer while 638 (40.85%) PLC patients were alive. Median survival time for PLC patients was 11.00 months, respectively. PLC patients with prior thyroid cancer have a lower risk of death (HR = 0.64; 95% CI: 0.48-0.86). Subgroup analyses stratified by gender displayed the similar relation in female patients with PLC. Prior thyroid cancer may be a protective factor for liver cancer death in PLC patients, especially in female patients.
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Lagou MK, Anastasiadou DP, Karagiannis GS. A Proposed Link Between Acute Thymic Involution and Late Adverse Effects of Chemotherapy. Front Immunol 2022; 13:933547. [PMID: 35844592 PMCID: PMC9283860 DOI: 10.3389/fimmu.2022.933547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Epidemiologic data suggest that cancer survivors tend to develop a protuberant number of adverse late effects, including second primary malignancies (SPM), as a result of cytotoxic chemotherapy. Besides the genotoxic potential of these drugs that directly inflict mutational burden on genomic DNA, the precise mechanisms contributing to SPM development are poorly understood. Cancer is nowadays perceived as a complex process that goes beyond the concept of genetic disease and includes tumor cell interactions with complex stromal and immune cell microenvironments. The cancer immunoediting theory offers an explanation for the development of nascent neoplastic cells. Briefly, the theory suggests that newly emerging tumor cells are mostly eliminated by an effective tissue immunosurveillance, but certain tumor variants may occasionally escape innate and adaptive mechanisms of immunological destruction, entering an equilibrium phase, where immunologic tumor cell death "equals" new tumor cell birth. Subsequent microenvironmental pressures and accumulation of helpful mutations in certain variants may lead to escape from the equilibrium phase, and eventually cause an overt neoplasm. Cancer immunoediting functions as a dedicated sentinel under the auspice of a highly competent immune system. This perspective offers the fresh insight that chemotherapy-induced thymic involution, which is characterized by the extensive obliteration of the sensitive thymic epithelial cell (TEC) compartment, can cause long-term defects in thymopoiesis and in establishment of diverse T cell receptor repertoires and peripheral T cell pools of cancer survivors. Such delayed recovery of T cell adaptive immunity may result in prolonged hijacking of the cancer immunoediting mechanisms, and lead to development of persistent and mortal infections, inflammatory disorders, organ-specific autoimmunity lesions, and SPMs. Acknowledging that chemotherapy-induced thymic involution is a potential risk factor for the emergence of SPM demarcates new avenues for the rationalized development of pharmacologic interventions to promote thymic regeneration in patients receiving cytoreductive chemotherapies.
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Affiliation(s)
- Maria K. Lagou
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United States
- Tumor Microenvironment and Metastasis Program, Albert Einstein Cancer Center, Bronx, NY, United States
| | - Dimitra P. Anastasiadou
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United States
- Tumor Microenvironment and Metastasis Program, Albert Einstein Cancer Center, Bronx, NY, United States
| | - George S. Karagiannis
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY, United States
- Tumor Microenvironment and Metastasis Program, Albert Einstein Cancer Center, Bronx, NY, United States
- Cancer Dormancy and Tumor Microenvironment Institute, Albert Einstein Cancer Center, Bronx, NY, United States
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, United States
- Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY, United States
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Ye J, Hu S, Zhang W, Zhang D, Zhang Y, Yu D, Peng J, Xu J, Wei Y. Better Prognosis and Survival in Esophageal Cancer Survivors After Comorbid Second Primary Malignancies: A SEER Database-Based Study. Front Surg 2022; 9:893429. [PMID: 35769151 PMCID: PMC9235858 DOI: 10.3389/fsurg.2022.893429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background With the development of surgical techniques and advances in systemic treatments, the survival time of esophageal cancer survivors has increased; however, the chance of developing a second primary malignancy (SPM) has also increased. These patients’ prognosis and treatment plans remain inconclusive. Objectives We aimed to evaluate and predict the survival of patients with esophageal cancer with second primary tumors, to provide insights and the latest data on whether to pursue more aggressive treatment. Materials and Methods We selected esophageal cancer cases from the latest available data from the SEER database on April 15, 2021. We performed life table analysis, Kaplan–Meier analysis, and univariate and multivariate Cox proportional hazards analysis to assess the patient data. We conducted multiple Cox regression equation analyses under multiple covariate adjustment models, and performed a stratified analysis of multiple Cox regression equation analysis based on different covariates. To describe our study population more simply and clearly, we defined the group of patients with esophageal cancer combined with a second primary malignant tumor (the first of two or more primaries) as the EC-SPM group. Results Our analysis of 73,456 patients with esophageal cancer found the median survival time of the EC-SPM group was 47.00 months (95% confidence interval (CI), 43.87–50.13), and the mean survival time was 74.67 months (95% CI, 72.12–77.22). Kaplan–Meier curves of different esophageal cancer survivors showed that the survival of the EC-SPM group was significantly better than that of the other groups (p < 0.01). Univariate Cox regression analysis showed that compared with only one malignancy only group, the hazard ratio (HR) of the EC-SPM group was 0.95 (95% CI, 0.92–0.99; p < 0.05). In the multivariate Cox regression analysis under different adjustment models, the EC-SPM group had a reduced risk of death compared with the one primary malignancy only group (HR < 1, p < 0.05). Conclusion Survivors of esophageal cancer with a second primary malignant cancer have a better prognosis, but require more aggressive treatment. This study provided new evidence and new ideas for future research on the pathophysiological mechanism and treatment concepts of esophageal cancer combined with SPM.
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Liu Y, Zhang P, Zhang Y, Zheng L, Xu W, Hou D, Kang Z. Clinical characteristics and overall survival nomogram of second primary malignancies after prostate cancer, a SEER population-based study. Sci Rep 2021; 11:1293. [PMID: 33446816 PMCID: PMC7809269 DOI: 10.1038/s41598-020-80534-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/22/2020] [Indexed: 01/21/2023] Open
Abstract
Prostate cancer (PCa) is the most prevalent cancer among males and the survival period of PCa has been significantly extended. However, the probability of suffering from second primary malignancies (SPMs) has also increased. Therefore, we downloaded SPM samples from the SEER database and then retrospectively analyzed the general characteristics of 34,891 PCa patients diagnosed between 2000 and 2016. After excluding cases with unknown clinical information, 2203 patients were used to construct and validate the overall survival (OS) nomogram of SPM patients after PCa. We found that approximately 3.69% of PCa patients were subsequently diagnosed with SPMs. In addition, the three most prevalent sites of SPM were respiratory and intrathoracic organs, skin, and hematopoietic system. The top three histological types of SPMs were squamous cell carcinoma, adenoma and adenocarcinoma, nevi and melanoma. Through univariate and multivariate Cox regression analysis, we found that the site of SPM, age, TNM stage, SPM surgery history, and PCa stage were associated with the OS of SPM. By virtue of these factors, we constructed a nomogram to predict the OS of SPM. The C-index in the training set and validation set were 0.824 (95CI, 0.806-0.842) and 0.862 (95CI, 0.840-0.884), respectively. Furthermore, we plotted the receiver operating characteristic curve (ROC) and the area under curve (AUC) which showed that our model performed well in assessing the 3-year (0.861 and 0.887) and 5-year (0.837 and 0.842) OS of SPMs in the training and validation set. In summary, we investigated the general characteristics of SPMs and constructed a nomogram to predict the prognosis of SPM following PCa.
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Affiliation(s)
- Yi Liu
- Department of Urology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Kangfu Street, Zhengzhou, 450052, Henan, China
| | - Peipei Zhang
- Department of Pediatrics, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Yinghao Zhang
- Department of Urology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Kangfu Street, Zhengzhou, 450052, Henan, China
| | - Lichuan Zheng
- Department of Urology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Kangfu Street, Zhengzhou, 450052, Henan, China
| | - Wenbo Xu
- Department of Urology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Kangfu Street, Zhengzhou, 450052, Henan, China
| | - Dongtao Hou
- Department of Urology, Xinzheng Hospital, Zhengzhou, Henan, China
| | - Zhengjun Kang
- Department of Urology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou University, Kangfu Street, Zhengzhou, 450052, Henan, China.
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Comprehensive Analysis of Multiple Primary Cancers in Patients with Esophageal Squamous Cell Carcinoma Undergoing Esophagectomy. Ann Surg 2020; 276:305-311. [PMID: 32941275 DOI: 10.1097/sla.0000000000004490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To elucidate the latest epidemiology and risk factors for multiple primary cancers (MPCs), and the association between neoadjuvant chemotherapy (NAC) and postoperative metachronous cancer (PMC) in patients with esophageal squamous cell carcinoma (ESCC) who underwent esophagectomy. SUMMARY OF BACKGROUND DATA Background data to derive appropriate screening strategies are insufficient. METHODS This study consisted of three retrospective investigations. A total of 766 consecutive patients with ESCC who underwent esophagectomy between April 2005 and December 2019 were eligible for epidemiological analysis. Of these, 688 patients without missing data were analyzed for the risk of MPCs. In total, 364 patients who underwent NAC (115) and no preoperative treatments (249) were investigated for the association between NAC and PMC. RESULTS Of 766 patients, 288 (38%) patients experienced 357 MPCs in their life. PMCs identified after the completion of 5-year postoperative follow-up were significantly more advanced (P = 0.019). Male sex [hazard ratio (HR) = 3.04, P = 0.038], older age (HR = 2.39, P < 0.001), and diabetes mellitus (HR = 1.76, P = 0.034) were risk factors for preoperative metachronous cancers. Heavy smoking (HR = 1.70, P = 0.014) and drinking (HR = 1.61, P = 0.029) were risk factors for synchronous cancers. NAC significantly reduced PMC incidence (P = 0.043). NAC showed a trend to contribute to improved survival via reduced deaths from PMCs, although this did not reach significance (P = 0.082). CONCLUSIONS ESCC is associated with a high risk of MPCs. Continuing follow-up for PMCs after the completion of 5-year postoperative follow-up is important. NAC may reduce PMCs, representing a novel mechanism for improving survival in patients with locally advanced ESCC.
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Bian X, Xia J, Wang K, Wang Q, Yang L, Wu W, Li L. The effects of a prior malignancy on the survival of patients with ovarian cancer: a population-based study. J Cancer 2020; 11:6178-6187. [PMID: 33033501 PMCID: PMC7532502 DOI: 10.7150/jca.46584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background: With the improvement in the prognostic outcomes of multiple malignancies, the population of cancer survivors is growing rapidly and is at higher risk of developing secondary ovarian cancer. However, the prevalence and clinical outcomes of prior cancer among newly diagnosed ovarian cancer patients remain unknown. Methods: Patients diagnosed with ovarian cancer between 2004 and 2015 were identified using the Surveillance, Epidemiology, and End Results database. Patients were divided into two groups based on whether there was a prior malignancy. A multivariate Cox regression analysis was used to calculate all-cause and ovarian-specific survival. Furthermore, we conducted subgroup survival analyses of patients stratified by previous cancer site to explore the associations between prior cancer site and survival outcomes. Results: A total of 52,182 patients with primary ovarian cancer were identified, and 3.6% (n=1,860) had a documented prior malignancy. In multivariate analyses, patients with prior malignancies had a worse all-cause and ovarian cancer-specific prognosis than those without. In subset analyses, patients with a history of thyroid cancer had a better all-cause and ovarian cancer-specific prognosis, and patients with prior colorectal, urinary system, skin, lung, haematologic and stomach cancers were at risk of decreased survival compared to that of patients without a prior cancer. Conclusions: Prior malignancy has an adverse impact on the survival of patients with ovarian cancer, and the impact on prognostic outcomes varies by different prior cancer sites. The inconsistent survival effects of previous malignancies should be considered in clinical trial design and recruitment.
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Affiliation(s)
- Xiaoyuan Bian
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Jiafeng Xia
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Kaicen Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Qiangqiang Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Liya Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Wenrui Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University, Hangzhou, P. R. China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, P. R. China
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