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Zhou J, Liu X, Liang X, Wei S. Association between depressive symptoms and second primary cancer in cancer survivors: Insights from a nationally representative study. Gen Hosp Psychiatry 2024; 90:150-156. [PMID: 39197229 DOI: 10.1016/j.genhosppsych.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/01/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the association between depressive symptoms and second primary cancer (SPC) in U.S. cancer survivors. METHODS Cancer survivors from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study, and depressive symptoms were defined by the Patient Health Questionnaire 9 (PHQ-9). The association between depressive symptoms and SPC was assessed via multiple logistic regression, restricted cubic spline (RCS), sensitivity, and subgroup analyses. RESULTS This study involved 2315 participants representing >15 million noninstitutionalized U.S. residents. Multivariate logistic regression fully adjusted for confounders revealed that cancer survivors with a PHQ-9 score ≥ 10 had a greater risk of developing SPC than those with a PHQ-9 score of 0-4 ([OR] = 1.88, 95% [CI] = 1.20-2.89, p = 0.005). The RCS showed a linear positive correlation between the PHQ-9 score and SPC (p for overall = 0.017). The robustness of this association was subsequently confirmed via multiple interpolation of missing data and different cluster-level methods (namely weighted linear regression) as sensitivity analyses. Furthermore, subgroup analyses confirmed this correlation was stronger in participants with sleep duration <7 h (p for interaction = 0.036). CONCLUSION Moderate to severe depressive symptoms in cancer survivors were associated with an increased risk of developing SPC, especially at <7 h of sleep.
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Affiliation(s)
- Jie Zhou
- Department of Gastrointestinal Oncology Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Hubei Province, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Wuhan, Wuhan 430079, Hubei, China
| | - Xiaoxin Liu
- Department of Nephrology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430077, Hubei, China
| | - Xinjun Liang
- Colorectal Cancer Clinical Research Center of Hubei Province, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Wuhan, Wuhan 430079, Hubei, China; Department of Abdominal Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, Hubei, China.
| | - Shaozhong Wei
- Department of Gastrointestinal Oncology Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Hubei Province, Wuhan 430079, Hubei, China; Colorectal Cancer Clinical Research Center of Wuhan, Wuhan 430079, Hubei, China.
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Kjaer TK, Andersen EAW, Ursin G, Larsen SB, Bidstrup PE, Winther JF, Borre M, Johansen C, Dalton SO. Cumulative incidence of second primary cancers in a large nationwide cohort of Danish cancer survivors: a population-based retrospective cohort study. Lancet Oncol 2024; 25:126-136. [PMID: 38048803 DOI: 10.1016/s1470-2045(23)00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND A new primary cancer is a serious late effect of a pre-existing cancer diagnosis, and can be attributed to hereditary cancer syndromes, immune or hormonal factors, cancer treatment, or modifiable lifestyle or environmental factors. We investigated the absolute and relative incidence of second primary cancers in a large cohort of Danish cancer survivors. Furthermore, we examined the association between alcohol-related, smoking-related, virus-related, and hormone-related first and second primary cancers. METHODS In this retrospective cohort study, we identified a cohort of Danish adults (aged ≥40 years) diagnosed with cancer from Jan 1, 1997, to Dec 31, 2014 and alive 1 year after diagnosis. Follow-up was from date of first cancer diagnosis and lasted up to 24 years, ending on Dec 31, 2020. Cohort identification and information on second primary cancers was obtained from the Danish Cancer Registry, and comorbidity and sociodemographic information was obtained from Danish population-based registries. Overall, and for 27 cancer types, cumulative incidence functions and Cox proportional hazard regression models were used to estimate the incidence of second primary cancer and death, and hazard ratios (HRs) and 95% CIs of second primary cancer adjusted for sex, age and year of diagnosis, cohabitation status, income, and comorbidity. FINDINGS 457 334 Danish adults were included in our study (230 150 [50·3%] male individuals and 227 184 [49·7%] female individuals; median age at diagnosis 68·3 years, IQR 59·7-76·6; median follow-up 3·6 years, IQR 0·6-9·3). The cumulative incidence of second primary cancer increased over time from 6·3% (95% CI 6·2-6·4) 5 years after diagnosis to 10·5% (10·4-10·6) 10 years after diagnosis and to 13·5% (13·4-13·7) 15 years after diagnosis. The highest cumulative incidence of second primary cancer 10 years after diagnosis was observed in survivors of cancers in the larynx (21·8%, 20·5-23·1), oropharynx and oral cavity (19·5%, 18·7-20·3), and bladder and urinary tract (18·5%, 18·0-19·0). Survivors of cancers related to alcohol (HR 1·09, 95% CI 1·06-1·13), smoking (1·73, 1·68-1·78), diet high in red or processed meat (1·32, 1·24-1·39), or virus (1·23, 1·13-1·35) were at increased risk of developing a second cancer with the same aetiology, whereas having had a hormone-related first cancer was associated with lower risk of a second hormone-related cancer (0·77, 0·73-0·81). INTERPRETATION Our results could help optimise prevention efforts targeting modifiable risk factors to reduce risk of developing a second primary cancer. FUNDING Nordic Cancer Union and The Health Foundation (Helsefonden).
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Affiliation(s)
| | | | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Signe Benzon Larsen
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Christoffer Johansen
- Center for Cancer Late Effect Research CASTLE, Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Cancer Survivorship, Danish Cancer Institute, Copenhagen, Denmark; Danish Research Center for Equality in Cancer, Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark; Institute of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
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Somi MH, Dolatkhah R, Asvadi Kermani I, Sepahi S, Youzbashi N, Nezamdoust M, Abedi-Ardekani B. Providing Suggested Rules for Multiple Primary Cancer Recording, Coding and Registering in Population-based Cancer Registry. Asian Pac J Cancer Prev 2023; 24:1905-1916. [PMID: 37378918 PMCID: PMC10505895 DOI: 10.31557/apjcp.2023.24.6.1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Multiple primary cancers (MPC) present many coding difficulties, while a distinction should be made between new cases and those with metastasis and/or extension and recurrence of the primary ones. We aimed to reflect on the experiences and results of data quality control of the East Azerbaijan/Iran Population-Based Cancer Registry and present our suggested rules for reporting, recording and registering multiple primary cancer. METHODS Comparability, validity, timeliness, and completeness of data assessment were performed. As a result, we created a consulting team including expert oncologists, pathologists, and gastroenterologists to discuss for multiple primary tumors recording, identifying, coding and registering. RESULTS In case of confirmed Blood malignancies with definite BMB results, Brain and/or Bone involvements are always metastatic. In most cases of multiple cancers with the same morphological types, the earlier should be registered as primary tumor. In most of the synchronous multiple cancers, familial cancer syndromes should be considered and rules out. In case of two tumors diagnosed at the same time in colon and rectum, primary site should be detected by T stage or tumor sizes. In case of multiple tumors in Recto-sigmoid, Colon , and Rectum the earlier history of tumor should be considered as primary site. This rule was applied for Female Genital tumors, as earlier site is always the Primary cancer and other tumors should be registered as metastatic sites. Conclusion: Given the complexity of coding MPCs, we suggested some additional rules for identifying, recording, coding, and registering multiple primary cancers in the context of the EA-PBCR program.
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Affiliation(s)
- Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Roya Dolatkhah
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Iraj Asvadi Kermani
- Hematology and Medical Oncology, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Sepideh Sepahi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Narges Youzbashi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Marzieh Nezamdoust
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Pruitt SL, Tavakkoli A, Zhu H, Heitjan DF, Gerber DE, Singal AG, Halm EA, Beg MS, Maddineni B, Kansagra AJ, Murphy CC. Survival of cancer survivors with a new pancreatic cancer diagnosis. Cancer Med 2023; 12:200-212. [PMID: 35674139 PMCID: PMC9844592 DOI: 10.1002/cam4.4903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Persons newly diagnosed with pancreas cancer and who have survived a previous cancer are often excluded from clinical trials, despite limited evidence about their prognosis. We examined the association between previous cancer and overall survival. METHODS This US population-based cohort study included older adults (aged ≥66 years) diagnosed with pancreas cancer between 2005 and 2015 in the linked Surveillance, Epidemiology, and End Results-Medicare data. We used Cox proportional hazards models to estimate stage-specific effects of previous cancer on overall survival, adjusting for sociodemographic, treatment, and tumor characteristics. RESULTS Of 32,783 patients, 18.7% were previously diagnosed with another cancer. The most common previous cancers included prostate (29.0%), breast (18.9%), or colorectal (9.7%) cancer. More than half of previous cancers (53.9%) were diagnosed 5 or more years prior to pancreas cancer diagnosis or at an in situ or localized stage (47.8%). The proportions of patients surviving 1, 3, and 5 years after pancreas cancer were nearly identical for those with and without previous cancer. Median survival in months was as follows for those with and without previous cancer respectively: 7 versus 8 (Stage 0/I), 10 versus 10 (Stage II), 7 versus 7 (Stage III), and 3 versus 2 (Stage IV). Cox models indicated that patients with previous cancer had very similar or statistically equivalent survival to those with no previous cancer. CONCLUSIONS Given nearly equivalent survival compared to those without previous cancer, cancer survivors newly diagnosed with pancreas cancer should be considered for inclusion in pancreas cancer clinical trials.
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Affiliation(s)
- Sandi L. Pruitt
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Anna Tavakkoli
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Hong Zhu
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
| | - Daniel F. Heitjan
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Statistical ScienceSouthern Methodist UniversityDallasTexasUSA
| | - David E. Gerber
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Amit G. Singal
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ethan A. Halm
- Rutgers Biological Health Sciences (RBHS)Rutgers UniversityNew BrunswickNew JerseyUSA
- Robert Wood Johnson Medical SchoolDepartment of MedicineNew BrunswickNew JerseyUSA
| | | | - Bhumika Maddineni
- Department of Population & Data SciencesUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ankit J. Kansagra
- Harold C. Simmons Comprehensive Cancer CenterDallasTexasUSA
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Caitlin C. Murphy
- School of Public HealthUniversity of Texas Health Science Center at HoustonHoustonTexasUSA
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Perez M, Murphy CC, Pruitt SL, Rashdan S, Rahimi A, Gerber DE. Potential Impact of Revised NCI Eligibility Criteria Guidance: Prior Malignancy Exclusion in Breast Cancer Clinical Trials. J Natl Compr Canc Netw 2022; 20:792-799.e4. [PMID: 35830895 PMCID: PMC9906999 DOI: 10.6004/jnccn.2022.7017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many individuals with cancer have survived a prior cancer and for this reason may have been excluded from clinical trials. Recent NCI guidance recommends including these individuals, especially when the risk of the prior malignancy interfering with either safety or efficacy endpoints is very low. Using breast cancer as an example, we determined the potential effect this policy change may have on clinical trial accrual. PATIENTS AND METHODS We reviewed protocols of NCI-sponsored breast cancer clinical trials activated in 1991 through 2016. We quantified prevalence of prior cancer-related exclusion criteria and assessed the association with trial characteristics using Fisher's exact tests. Using SEER data, we estimated the prevalence and timing of prior primary (nonbreast) cancer diagnoses among patients with breast cancer. RESULTS Among 87 clinical trials (total target enrollment, 137,253 patients), 77% excluded individuals with prior cancer, most commonly (79%) within the preceding 5 years. Among trials with radiographic response or toxicity endpoints, 69% excluded prior cancer. In SEER data, the prevalence of a prior (nonbreast) cancer diagnosis ranged from 5.7% to 7.7%, depending on breast cancer stage, of which 39% occurred within 5 years of the incident breast cancer. For trials excluding prior cancer, the estimated proportion of patients excluded for this reason ranged from 1.3% to 5.8%, with the estimated number of excluded patients ranging from 1 to 288. CONCLUSIONS More than three-fourths of NCI-sponsored breast cancer clinical trials exclude patients with prior cancer, including almost 70% of trials with response or toxicity endpoints. Given that >5% of patients with breast cancer have a history of prior cancer, in large phase III trials this practice may exclude hundreds of patients. Following recent NCI eligibility guidance, the inclusion of patients with prior cancer on breast cancer trials may have a meaningful impact on accrual.
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Affiliation(s)
- Matthew Perez
- School of Medicine, UT Southwestern Medical Center, Dallas TX
| | - Caitlin C. Murphy
- School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston TX
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
| | - Sawsan Rashdan
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Asal Rahimi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - David E. Gerber
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
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A Predictive Model to Differentiate Between Second Primary Lung Cancers and Pulmonary Metastasis. Acad Radiol 2022; 29 Suppl 2:S137-S144. [PMID: 34175210 DOI: 10.1016/j.acra.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a nomogram for differentiating second primary lung cancers (SPLCs) from pulmonary metastases (PMs). MATERIALS AND METHODS A total of 261 lesions from 253 eligible patients were included in this study. Among them, 195 lesions (87 SPLCs and 108 PMs) were used in the training cohort to establish the diagnostic model. Twenty-one clinical or imaging features were used to derive the model. Sixty-six lesions (32 SPLCs and 34 PMs) were included in the validation set. RESULTS After analysis, age, lesion distribution, type of lesion, air bronchogram, contour, spiculation, and vessel convergence sign were considered to be significant variables for distinguishing SPLCs from PMs. Subsequently, these variables were selected to establish a nomogram. The model showed good distinction in the training set (area under the curve = 0.97) and the validation set (area under the curve = 0.92). CONCLUSION This study found that the nomogram calculated from clinical and radiological characteristics could accurately classify SPLCs and PMs.
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7
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Survival analysis of patients with primary breast duct carcinoma and lung adenocarcinoma: a population-based study from SEER. Sci Rep 2021; 11:14790. [PMID: 34285322 PMCID: PMC8292419 DOI: 10.1038/s41598-021-94357-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/08/2021] [Indexed: 11/09/2022] Open
Abstract
The appeal to enroll patients with primary breast and lung cancer in clinical trials is increasing, but survival of these two primary cancers remains to be elucidated. This study analyzed the prognosis of primary breast duct carcinoma with subsequent lung adenocarcinoma (BCLA) and primary breast duct carcinoma with prior lung adenocarcinoma (LABC). Cohorts of 3,515 patients with BCLA and 654 patients with LABC were identified from the Surveillance, Epidemiology, and End Results database. Patients were classified into simultaneous two primary cancer (sTPC), metachronous two primary cancer (mTPC1), or mTPC2 groups when the interval times between breast and lung cancer were within 6 months, between 7 and 60 months, or over 60 months, respectively. The propensity score matching program (PSM) was applied to determine the survival of BCLA/LABC relative to single breast/lung cancer. Cox proportional hazard regression model and competing risk modes were performed to identify confounders associated with all-cause and cancer-specific death, respectively. Survival of patients with LABC/BCLA relative to single breast/lung cancer was accessed via median survival time. The survival of patients with BCLA/LABC was generally poor compared with the survival of those with single breast cancer. The PSM-estimated HR in the sTPC group with BCLA and in the mTPC1 and mTPC2 groups with LABC were 0.75 (95% CI 0.62–0.90), 0.52 (95% CI 0.27–0.98), and 0.36 (95% CI 0.20–0.65), respectively, whereas the SHRs were 0.80 (95% CI 0.66–0.97), 0.68 (95% CI 0.34–1.34), and 0.46 (95% CI 0.27–0.80), respectively, compared with those in the single lung cancer group. By contrast, the survival rates of the remaining patients did not differ. The median survival times since secondary malignancy were 42, 23, and 20 months in the sTPC, mTPC1, and mTPC2 groups with BCLA, respectively, and 18, 60, and 180 months in those with LABC, respectively. For patients with BCLA, the adjusted Cox regression suggested incidences of all-cause deaths in mTPC1group were statically higher than those in sTPC group, whereas the incidences of all-cause and cancer-specific death in the mTPC1 and mTPC2 groups were statistically lower than those in the sTPC group. The prognosis of patients with breast cancer and subsequent lung cancer of over 18 months was not significantly different than that of single lung cancer, which supported the profound appeal to increase the involvement of these two primary cancers in potential beneficial clinical trials. For patients with lung cancer and prior breast cancer of within 6 months and subsequent breast cancer of over 18 months, prognosis was improved relative to single lung cancer. Therefore, additional attention is needed to eliminate the potential bias may when these patients are recruited in the clinical trials.
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Pruitt SL, Gerber DE, Zhu H, Heitjan DF, Maddineni B, Xiong D, Singal AG, Tavakkoli A, Halm EA, Murphy CC. Survival of patients newly diagnosed with colorectal cancer and with a history of previous cancer. Cancer Med 2021; 10:4752-4767. [PMID: 34190429 PMCID: PMC8290226 DOI: 10.1002/cam4.4036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with previous cancer are often excluded from clinical trials despite limited evidence about their prognosis. We examined the effect of previous cancer on overall and colorectal cancer (CRC)-specific survival of patients newly diagnosed with CRC. This population-based cohort study from the U.S.A. included patients aged ≥66 years and diagnosed with CRC between 2005 and 2015 in linked Surveillance, Epidemiology, and End Results-Medicare data. We estimated the stage-specific effects of a previous cancer on overall survival using Cox regression and on CRC-specific survival using competing risk regression. We also examined the effect of previous cancer type, timing, and stage on overall survival. Of 112,769 patients, 14.1% were previously diagnosed with another cancer--commonly prostate (32.9%) or breast (19.4%) cancer, with many (47.1%) diagnosed <5 years of CRC. For all CRC stages except IV, in which there was no difference, patients with previous cancer (vs. without) had worse overall survival. However, patients with previous cancer had improved CRC-specific survival. Overall survival for those with stage 0-III CRC varied by previous cancer type, timing, and stage; for example, patients with previous melanoma had overall survival equivalent to those with no previous cancer. Our results indicate that, in general, CRC patients with previous cancer have worse overall survival but superior CRC-specific survival. Given their equivalent survival to those without previous cancer, patients with previous melanoma and those with stage IV CRC with any type of previous cancer should be eligible to participate in clinical trials.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hong Zhu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Bhumika Maddineni
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Danyi Xiong
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Amit G Singal
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anna Tavakkoli
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Ebia MI, Capone S, Ricker C, Thomas JS, Tulpule V, Kang I, D'Souza A, Freyer DR, Miller K, In GK. A Case Series of Multiple Primary Malignancies Among Patients With Advanced Melanoma. Cureus 2021; 13:e15480. [PMID: 34262818 PMCID: PMC8260217 DOI: 10.7759/cureus.15480] [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] [Accepted: 06/06/2021] [Indexed: 11/18/2022] Open
Abstract
Multiple primary malignancies (MPM) are described as two or more primary tumors within the same individual. The impact of MPM on the tumor microenvironment among patients with melanoma is poorly understood. Here, we describe this unique group of patients who have both advanced melanoma and at least one other primary malignancy and report their survival outcomes. In this study, patients with advanced melanoma and a second primary malignancy were identified. Medical records were reviewed for cancer treatment history. Kaplan-Meier methods were used to derive survival curves and estimate overall survival (OS), and log-rank tests were used to compare OS. Among 11 MPM patients, the most common non-melanoma cancers were breast (n = 3) and thyroid (n = 3). Median OS was 153.5 months for all patients. Median OS for synchronous MPM (sMPM) and metachronous MPM (mMPM) were 83.1 and 196.7 months, respectively (p= 0.10). Median OS was not reached when melanoma was diagnosed first, and 153.5 months when diagnosed second (p= 0.45). For six patients receiving immunotherapy for melanoma, there was a 100% complete response rate. In conclusion, patients with melanoma are at risk of secondary malignancies, including breast and thyroid cancer. The timing of secondary malignancies may impact prognosis. Further study of the impact of immunotherapy on MPM is warranted.
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Affiliation(s)
- Matthew I Ebia
- Department of Internal Medicine, Los Angeles County University of Southern California Medical Center, Los Angeles, USA
| | - Stephen Capone
- Department of Neurosurgery, MD Anderson Cancer Center, Houston, USA
| | - Charité Ricker
- Division of Oncology, University of Southern California - Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Jacob S Thomas
- Division of Oncology, University of Southern California - Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Varsha Tulpule
- Division of Oncology, University of Southern California - Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Irene Kang
- Division of Oncology, University of Southern California - Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - Anishka D'Souza
- Division of Oncology, University of Southern California - Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - David R Freyer
- Department of Preventive Medicine, University of Southern California - Keck School of Medicine, Los Angeles, USA
| | - Kimberly Miller
- Departments of Preventive Medicine and Dermatology, University of Southern California - Keck School of Medicine, Los Angeles, USA
| | - Gino K In
- Division of Oncology, University of Southern California - Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, USA.,Department of Dermatology, University of Southern California - Keck School of Medicine, Los Angeles, USA
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Second primary cancers: a retrospective analysis of real world data using the enhanced medical research engine ConSoRe in a French comprehensive cancer center. Int J Clin Oncol 2021; 26:1793-1804. [PMID: 34091824 DOI: 10.1007/s10147-021-01963-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/03/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Second primary cancers (SPC) account for 18% of all cancers. We used the enhanced medical/health data mining tool ConSoRe to search aggregated data, analyze electronic patient records (EPR), and better characterize patients with SPC. METHODS This retrospective cohort study used ConSoRe to identify EPRs from patients with SPC referred to the regional cancer center Leon Bérard from 1993 to 2017, and examined characteristics of patients with SPC, frequencies of first primary cancer (FPC) localization in the global population of patients with SPC, and time to SPC. Data set was extracted on January 1, 2018. RESULTS Among 296,530 EPRs, we identified 157,187 patients with FPC, including 13,002 (8%) patients with SPC. Between 2000 and 2010, the rate of SPC was 34%, and 52% of SPC were identified in the last years (2010-2017). In men, main cancers were head and neck cancer, lymphoma, and prostate carcinoma accounting for 15.6%, 12.8%, and 10.5% of FPC, while the three most common SPC were head and neck cancer (13.2%), lung cancer (11.8%) and lymphoma (9.2%). In women, breast cancers, lymphoma, and skin cancers accounted for 48.8%, 8%, and 5.1% of first cancers, and for 31.1%, 7% and 6% of SPC. CONCLUSION The data mining tool ConSoRe contributes to access to real world data, and to better characterize patients with SPC. Expanding such approach to any comprehensive center will allow a global overview of the follow-up of patients with cancer, and help to improve long-term management and adapt surveillance.
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Pruitt SL, Zhu H, Heitjan DF, Rahimi A, Maddineni B, Tavakkoli A, Halm EA, Gerber DE, Xiong D, Murphy CC. Survival of women diagnosed with breast cancer and who have survived a previous cancer. Breast Cancer Res Treat 2021; 187:853-865. [PMID: 33620590 PMCID: PMC8318112 DOI: 10.1007/s10549-021-06122-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Many women diagnosed with breast cancer have survived previous cancer; yet little is known about the impact of previous cancer on overall and cancer-specific survival. METHODS This population-based cohort study using SEER-Medicare data included women (age ≥ 66 years) diagnosed with breast cancer between 2005 and 2015. Separately by breast cancer stage, we estimated effect of previous cancer on overall survival using Cox regression and on cause-specific survival using competing risk regression; all survival analyses adjusted for covariates. RESULTS Of 138,576 women diagnosed with breast cancer, 8% had a previous cancer of another organ site, most commonly colorectal or uterine cancer or melanoma. Many of these women (46.3%) were diagnosed within 5 years of breast cancer. For all breast cancer stages except IV wherein there was no difference, women with vs. without previous cancer had worse overall survival. This survival disadvantage was driven by deaths due to the previous cancer and other causes. In contrast, women with previous cancer generally had favorable breast-cancer-specific survival, although this varied by stage. Overall survival varied by previous cancer type, timing, and stage; previous lung cancer, cancer diagnosed within 1 year of incident breast cancer, and previous cancer at a distant stage were associated with the worst survival. In contrast, women with a previous melanoma had equivalent overall survival to women without previous cancer. CONCLUSION We observed variable impact of previous cancer on overall and breast-cancer-specific survival depending on breast cancer stage at diagnosis and the type, timing, and stage of previous cancer.
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Affiliation(s)
- Sandi L Pruitt
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Hong Zhu
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Asal Rahimi
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bhumika Maddineni
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Anna Tavakkoli
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ethan A Halm
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David E Gerber
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Danyi Xiong
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Department of Statistical Science, Southern Methodist University, Dallas, TX, USA
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Rubió-Casadevall J, Galceran J, Ameijide A, Puigdemont M, Llauradó L, Marruecos J, Izquierdo A, Carulla M, Borràs JL, Marcos-Gragera R, Gumà J. Population-based risk assessment of second primary cancers following a first head and neck cancer: patterns of association and difficulties of its analysis. Clin Transl Oncol 2020; 23:788-798. [PMID: 32815088 DOI: 10.1007/s12094-020-02470-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The diagnosis of a second primary cancer (SPC) is a major concern in the follow-up of survivors of a primary head and neck cancer (HNC), but the anatomic subsites in the head and neck area are close, making it difficult to distinguish a SPC of a recurrence and therefore register it correctly. METHODS We performed a retrospective cohort study using data from two population-based cancer registries in Catalonia, Spain: the Tarragona Cancer Registry and the Girona Cancer Registry. All patients diagnosed with HNC during the period 1994-2013 were registered and followed-up to collect cases of SPC. We analysed the standardized incidence ratio (SIR) and the excess absolute risk (EAR) to determine the risk of second malignancies following a prior HNC. RESULTS 923 SPC were found in a cohort of 5646 patients diagnosed of a first head and neck cancer. Men had an increased risk of a SPC with a SIR of 2.22 and an EAR of 216.76. Women also had an increased risk with a SIR of 2.02 and an EAR of 95.70. We show the risk for different tumour sites and discuss the difficulties of the analysis. CONCLUSION The risks of a SPC following a prior HNC in Tarragona and Girona are similar to those previously found in other similar cohorts. It would appear to be advisable to make a revision of the international rules of classification of multiple tumours, grouping the sites of head and neck area with new aetiological criteria to better determine and interpret the risks of SPC obtained in these studies.
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Affiliation(s)
- J Rubió-Casadevall
- Medical Oncology Department, Institut Català d'Oncologia de Girona, Avda França s/n, 17005, Girona, Spain.
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.
| | - J Galceran
- Tarragona Cancer Registry, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - A Ameijide
- Tarragona Cancer Registry, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - M Puigdemont
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - L Llauradó
- Tarragona Cancer Registry, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - J Marruecos
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Radiotherapy Oncology Department, Institut Català d'Oncologia de Girona, Girona, Catalonia, Spain
| | - A Izquierdo
- Medical Oncology Department, Institut Català d'Oncologia de Girona, Avda França s/n, 17005, Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - M Carulla
- Tarragona Cancer Registry, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - J L Borràs
- Tarragona Cancer Registry, Hospital Universitari de Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
- Institute of Oncology of Southern Catalonia, Hospital Universitari de Sant Joan, IISPV, Reus, Spain
| | - R Marcos-Gragera
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - J Gumà
- Institute of Oncology of Southern Catalonia, Hospital Universitari de Sant Joan, IISPV, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Catalonia, Spain
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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]
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14
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Feller A, Matthes KL, Bordoni A, Bouchardy C, Bulliard JL, Herrmann C, Konzelmann I, Maspoli M, Mousavi M, Rohrmann S, Staehelin K, Arndt V. The relative risk of second primary cancers in Switzerland: a population-based retrospective cohort study. BMC Cancer 2020; 20:51. [PMID: 31964352 PMCID: PMC6974968 DOI: 10.1186/s12885-019-6452-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND More people than ever before are currently living with a diagnosis of cancer and the number of people concerned is likely to continue to rise. Cancer survivors are at risk of developing a second primary cancer (SPC). This study aims to investigate the risk of SPC in Switzerland. METHODS The study cohort included all patients with a first primary cancer recorded in 9 Swiss population-based cancer registries 1981-2009 who had a minimum survival of 6 months, and a potential follow-up until the end of 2014. We calculated standardized incidence ratios (SIR) to estimate relative risks (RR) of SPC in cancer survivors compared with the cancer risk of the general population. SIR were stratified by type of first cancer, sex, age and period of first diagnosis, survival period and site of SPC. RESULTS A total of 33,793 SPC were observed in 310,113 cancer patients. Both male (SIR 1.18, 95%CI 1.16-1.19) and female (SIR 1.20, 95%CI 1.18-1.22) cancer survivors had an elevated risk of developing a SPC. Risk estimates varied substantially according to type of first cancer and were highest in patients initially diagnosed with cancer of the oral cavity and pharynx, Hodgkin lymphoma, laryngeal, oesophageal, or lung cancer. Age-stratified analyses revealed a tendency towards higher RR in patients first diagnosed at younger ages. Stratified by survival period, risk estimates showed a rising trend with increasing time from the initial diagnosis. We observed strong associations between particular types of first and SPC, i.e. cancer types sharing common risk factors such as smoking or alcohol consumption (e.g. repeated cancer of the oral cavity and pharynx (SIRmales 20.12, 95%CI 17.91-22.33; SIRfemales 37.87, 95%CI 30.27-45.48). CONCLUSION Swiss cancer survivors have an increased risk of developing a SPC compared to the general population, particularly patients first diagnosed before age 50 and those surviving more than 10 years. Cancer patients should remain under continued surveillance not only for recurrent cancers but also for new cancers. Some first and SPCs share lifestyle associated risk factors making it important to promote healthier lifestyles in both the general population and cancer survivors.
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Affiliation(s)
- Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), University of Zurich, Zurich, Switzerland.
| | - Katarina L Matthes
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Bordoni
- Ticino Cancer Registry, Instituto cantonale di patologia, Locarno, Switzerland
| | - Christine Bouchardy
- Geneva Cancer Registry, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Jean-Luc Bulliard
- Vaud Cancer Registry, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Neuchâtel and Jura Cancer Registry, Neuchâtel, Switzerland
| | - Christian Herrmann
- Cancer Registry East Switzerland, St. Gallen, Switzerland
- Cancer Registry Grison & Glarus, Chur, Switzerland
| | | | | | - Mohsen Mousavi
- Cancer Registry East Switzerland, St. Gallen, Switzerland
- Cancer Registry Grison & Glarus, Chur, Switzerland
| | - Sabine Rohrmann
- Cancer Registry Zurich and Zug, University Hospital Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Volker Arndt
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), University of Zurich, Zurich, Switzerland
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Faial LCM, Silva RMCRA, Pereira ER, Faial CSG. A case of multiple myeloma and synchronous liposarcoma. Hematol Transfus Cell Ther 2019; 42:77-79. [PMID: 31601484 PMCID: PMC7031089 DOI: 10.1016/j.htct.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/21/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
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Yang YH, Deng Q, Yang TB, Gui Y, Zhang YX, Liu JB, Deng Q, Liu WF, Sun JJ. A case report of cholangiocarcinoma combined with moderately differentiated gastric adenocarcinoma. Medicine (Baltimore) 2019; 98:e16332. [PMID: 31348232 PMCID: PMC6709107 DOI: 10.1097/md.0000000000016332] [Citation(s) in RCA: 2] [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: 01/30/2023] Open
Abstract
RATIONALE Multiple primary carcinoma (MPM) refers to simultaneous or successive occurrence of ≥2 types of primary malignant tumors in a single organ or in different organs of the same individual. It is rarely seen in clinical practice. Among the various types of MPM, hilar cholangiocarcinoma combined with gastric cancer is extremely rare. PATIENT CONCERNS The patient was a 61-year-old man who was admitted to our hospital due to upper abdominal discomfort and yellow-stained skin mucosa for 9 days. DIAGNOSES Preoperative diagnosis: Considering the typical preoperative painless jaundice as well as his clinical imaging report, the patient received the following preoperative diagnosis: obstructive jaundice, type IV hilar cholangiocarcinoma based on Bismuth-Corlette classification, and no intrahepatic distant metastasis. Intraoperative diagnosis: The results of intraoperative snap freezing and laboratory examination indicated gastric adenocarcinoma. Therefore, the patient received an intraoperative diagnosis of obstructive jaundice, hilar cholangiocarcinoma, and gastric cancer. Postoperative pathological diagnosis: Postoperative pathological examination of the gastric lesion revealed the following results: ulcerative, moderately differentiated gastric adenocarcinoma and intestinal type in the Lauren classification of stomach cancer; moderately differentiated adenocarcinoma of the bile duct. INTERVENTIONS Surgical resection operation was carried out and the patient received chemotherapy after operation. But we could not strictly follow the relevant clinical guidelines to perform standardized operations and provide comprehensive treatment because of his economic situation, psychological factors, and the current medical environment in China. OUTCOMES The patient did not receive standardized postoperative therapy. Although he lived and worked normally for 8 months after the operation, he died 10 months after surgery. LESSONS This report reminds us to pay close attention to the likelihood of MPM and other low-incidence diseases. The physicians and imaging clinicians should explore all clinical possibilities to avoid misdiagnosis of this rare disease and formulate effective treatment plans to maximize the therapeutic benefits for the patient.
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Affiliation(s)
| | | | | | - Yang Gui
- Department of Hepatobiliary Surgery
| | | | - Jiang-Bo Liu
- Department of Breast Surgery, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology
| | - Qian Deng
- Faculty of Pharmaceutical Sciences, Luoyang Central Hospital affiliated to Zhengzhou University, Luoyang, China
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Peng C, Li Z, Gao H, Zou X, Wang X, Zhou C, Niu J. Synchronous primary sigmoid colon cancer and primary thyroid cancer followed by a malignant tumor of the kidney: Case report of multiple primary cancer and review of the literature. Oncol Lett 2018; 17:2479-2484. [PMID: 30719116 DOI: 10.3892/ol.2018.9867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022] Open
Abstract
Multiple primary cancer (MPC) is relatively rare. With the development of diagnostic and anti-cancer therapeutic techniques, the incidence of MPC is rising annually. However, the incidence of triple or quadruple cancers in a single patient remains low. In this report, the case of a 58-year-old male with triple malignant cancer is outlined. Synchronous sigmoid colon cancer and thyroid cancer were diagnosed in May 2015; on subsequent re-examination, metastasis to the liver and a malignant kidney tumor were also identified. The diagnosis was established via computed tomography (CT), Positron emission tomography-CT (PET-CT) and other laboratory examination results, including analysis of tumor markers and liver function, and was confirmed by pathological diagnosis. The patient underwent radical surgery and standardized chemotherapy. Through literature review, the definition, characteristics, classification, incidence, possible causes of and treatment strategies for MPC were more clearly understood. In addition, immunohistochemical staining of integrin αvβ6 was performed on patient tissue specimens, where integrin αvβ6 expression was confirmed in cancer of the colon, thyroid and liver, as a result of colonic metastasis. Therefore, the involvement of integrin αvβ6 in the malignant progression of MPC was hypothesized, which may aid the investigation of MPC etiology in the future.
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Affiliation(s)
- Cheng Peng
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,The Institute of Laparoscopic Minimally Invasive Surgery, Department of Hepatobiliary Surgery, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zequn Li
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,The Institute of Laparoscopic Minimally Invasive Surgery, Department of Hepatobiliary Surgery, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Huijie Gao
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,The Institute of Laparoscopic Minimally Invasive Surgery, Department of Hepatobiliary Surgery, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xueqing Zou
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,The Institute of Laparoscopic Minimally Invasive Surgery, Department of Hepatobiliary Surgery, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Xiao Wang
- Department of Pathology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Changkuo Zhou
- Department of Urology Surgery, Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jun Niu
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China.,The Institute of Laparoscopic Minimally Invasive Surgery, Department of Hepatobiliary Surgery, Shandong University, Jinan, Shandong 250012, P.R. China
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18
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Jung E, Fiore M, Gronchi A, Grignol V, Pollock RE, Chong SS, Chopra S, Hamilton AS, Tseng WW. Second Primary Malignancies in Patients with Well-differentiated/Dedifferentiated Liposarcoma. Anticancer Res 2018; 38:3535-3542. [PMID: 29848707 DOI: 10.21873/anticanres.12625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Well-differentiated/dedifferentiated (WD/DD) liposarcoma is a rare malignancy of putative adipocyte origin. To our knowledge, there have only been isolated case reports describing second primary cancer in patients with this disease. We report on a combined case series of such patients and explore the frequency of this occurrence using a national cancer database. MATERIALS AND METHODS Demographics and clinicopathological data were collected from patients with WD/DD liposarcoma who were found to have a concurrent or subsequent second primary cancer, at one of three sarcoma referral centers from 2014-2016. The Surveillance, Epidemiology and End Results (SEER) database was also queried to identify adult patients diagnosed with WD/DD liposarcoma between 1973-2012. Observed/expected (O/E) ratios of second primary malignancies among these cases were calculated by comparison to the age-adjusted cancer incidence in the general population using SEER*stat software. RESULTS In total, 26 out of 312 consecutive patients (8.3%) with WD/DD liposarcoma at our centers had a second primary cancer identified within 2 years of liposarcoma diagnosis. In the SEER database, among 1,845 patients with WD/DD liposarcoma, 75 (4.1%) had a second cancer within 2 years after liposarcoma diagnosis (O/E ratio=1.81, 99% confidence interval(CI)=1.33-2.40). Patients less than 50 years old at the time of liposarcoma diagnosis had a higher O/E ratio for second primary malignancy compared to older patients. A total of 269 patients (14.6%) developed a second cancer (O/E=1.33, 99% CI=1.15-1.54). CONCLUSION In some patients with WD/DD liposarcoma, there appears to be an increased risk of having a second primary cancer. Further validation and investigation is needed, as this finding may have implications (e.g. closer screening) for patients with this disease.
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Affiliation(s)
- Eric Jung
- Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, U.S.A
| | - Marco Fiore
- Department of Surgery, IRCCS Foundation National Tumor Institute, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, IRCCS Foundation National Tumor Institute, Milan, Italy
| | - Valerie Grignol
- Department of Surgery, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, U.S.A
| | - Raphael E Pollock
- Department of Surgery, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, U.S.A
| | - Susan S Chong
- Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, U.S.A
| | - Shefali Chopra
- Discovery Research Program, Department of Pathology and Laboratory Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - Ann S Hamilton
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, U.S.A
| | - William W Tseng
- Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, U.S.A.
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Ye Y, Otahal P, Wills KE, Neil AL, Venn AJ. Temporal trends in competing mortality from second and subsequent primary cancers, 1980-2014: An Australian population-based study. Cancer Epidemiol 2018; 55:61-67. [PMID: 29803142 DOI: 10.1016/j.canep.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Subsequent primary cancers (SPCs) compete with first cancers and non-cancer events as the primary cause of death among cancer patients. We aimed to assess temporal trends in SPC mortality since 1980 among adult-onset cancer patients in competing risk models. METHODS Patients registered with a first cancer in the population-based Tasmanian Cancer Registry, Australia, between 1980-2009 were followed up to December 2014. Cumulative incidence function (CIF) was used to estimate the cumulative incidence of cause-specific deaths in the presence of competing risks. The hazard ratios of SPC-specific deaths were assessed in two regression models: subdistribution hazard ratios from competing risk models (SHRs) and hazard ratios from Cox models (CHRs). RESULTS Overall, 5339 (9.3%) of 57,288 patients developed SPCs and 2494 died from SPCs during the follow-up. While the cumulative incidence of first cancer deaths at 5, 10, 15 and 20-years gradually decreased over periods of first cancer diagnosis, the cumulative incidence of SPC deaths did not. The SHRs for SPC-specific deaths increased from the reference period 1980-1984 to a peak for first cancers diagnosed in 1995-1999 (SHR = 1.18, 95%CI 1.03-1.35), before a decrease in 2005-2009 (SHR = 0.82, 95%CI 0.70-0.95) in competing risk models. However, this pattern was not consistent in CHRs. For individuals with specific first cancers, those with a first prostate cancer in 1995-1999 ha d the greatest SPC mortality risk (SHR = 2.08, 95%CI 1.29-3.36). CONCLUSION Competing risk models, but not Cox models, demonstrated temporal increases in SPC-specific mortality. Greater detection of non-fatal first prostate cancers appears to have contributed to this trend.
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Affiliation(s)
- Yuanzi Ye
- Menzies Institute for Medical Research, University of Tasmania, Australia; Department of Pathology, Anhui Medical University, China
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Karen E Wills
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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20
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Ye Y, Otahal P, Wills KE, Neil AL, Venn AJ. Temporal trends in the risk of second primary cancers among survivors of adult-onset cancers, 1980 through 2013: An Australian population-based study. Cancer 2018; 124:1808-1818. [PMID: 29370456 DOI: 10.1002/cncr.31247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The authors' systematic review indicated an increasing trend in the risk of second primary cancers (SPCs) from the 1980s to 2000 when considering studies from the United States and Australia. It is uncertain whether this trend has continued to increase since 2000. METHODS The current study was a population-based study of 51,802 individuals with adult-onset cancers identified in the Tasmanian Cancer Registry. Patients with a first cancer diagnosis made between 1980 and 2009 were followed up to December 2013. SPC risks were quantified using standardized incidence ratios (SIRs) and absolute excess risks (AERs). Trends in SPC risk were assessed using multivariable Poisson models. RESULTS With a median follow-up of 4.8 years (mean, 6.9 years), a total of 5339 SPCs were observed. The SIRs for any SPC increased from 0.98 (95% confidence interval, 0.90-1.07) after a first cancer diagnosis in 1980 through 1984 to 1.12 (95% confidence interval, 1.05-1.20) in 2005 through 2009. In multivariable Poisson models accounting for patient sex, age at the time of the first cancer diagnosis, follow-up interval, and first cancer type, the trend in SIRs increased significantly from 1980 through 2009 for all SPCs (P for trend <.001) and for specific SPCs of the head and neck, lung, digestive tract, and prostate (all P for trend <.05). From 2000 onward, the AER for specific SPCs after specific first cancers was highest for prostate cancer after first cancers of the urinary tract (AER, 54.3 per 10,000 person-years). CONCLUSIONS In Tasmania, the risk of SPCs among survivors of adult-onset cancers has increased with periods of first cancer diagnosis from 1980 through 2009. Increased cancer screening and improved medical imaging may have contributed to the greater risk in recent years. Cancer 2018;124:1808-18. © 2018 American Cancer Society.
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Affiliation(s)
- Yuanzi Ye
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Department of Pathology, Anhui Medical University, Hefei, China
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Karen E Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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