Effect of prior cancer on survival outcomes for patients with advanced prostate cancer

Prognostic effects of previous cancer history on patients with major salivary gland cancer

OBJECTIVES

To explore the prognostic effects of previous cancer history on patients with major salivary gland cancer (SGC).

SUBJECTS AND METHODS

SGC patients with (sec-SGC) and without (one-SGC) a previous cancer from the SEER database were identified. Cox proportional hazards regression (CoxPH) models were used to compare the prognosis between sec-SGC and one-SGC patients. Subgroup analyses for sec-SGC patients by gender, previous cancer types, previous cancer histology, and cancer diagnosis interval (CDI) were performed. Two CoxPH models were constructed to distinguish sec-SGC patients with different prognostic risks.

RESULTS

9098 SGC patients were enrolled. Overall, sec-SGC patients (adjusted HR [aHR] = 1.26, p < 0.001), especially those with a CDI ≤ 5 years (aHR = 1.47, p < 0.001), had worse overall survival (OS) than one-SGC patients. In subgroup analysis, only sec-SGC patients with a previous head and neck cancer who were female (aHR = 2.38, p = 0.005), with a CDI ≤ 5 years (aHR = 1.65, p = 0.007) or with a previous squamous cell carcinoma (aHR = 6.52, p < 0.001) had worse OS. Our models successfully differentiated all sec-SGC patients into high-, intermediate- and low-risk groups with different prognosis.

CONCLUSIONS

Sec-SGC patients with different previous cancer types, gender, CDI and previous cancer histology had varied prognosis. The models we constructed could help differentiate the prognosis of sec-SGC patients with different risks.

Examining Exclusion Criteria in Advanced Prostate Cancer Clinical Trials: An Assessment of recommendations From the American Society Of Clinical Oncology and Friends of Cancer Research

PURPOSE

Eligibility criteria illustrate the characteristics of the study population and promote the safety of participants. However, overreliance on restrictive eligibility criteria may limit the generalizability of outcomes. As a result, the American Society of Clinical Oncology (ASCO) and Friends of Cancer Research (Friends) issued statements to curtail these challenges. In this study, we aimed to assess restrictiveness in eligibility criteria across advanced prostate cancer clinical trials.

MATERIALS AND METHODS

We identified all phase I, II, and III advanced prostate cancer clinical trials between June 30, 2012, and June 30, 2022, through Clinicaltrials.gov. We evaluated whether a clinical trial excluded, conditionally included, or did not report 4 common criteria: brain metastases, prior or concurrent malignancies, HIV infection, and hepatitis B virus (HBV)/hepatitis C virus (HCV) infection. Performance status (PS) criteria were recorded based on the Eastern Cooperative Oncology Group (ECOG) scale.

RESULTS

Out of 699 clinical trials within our search strategy, 265 (37.9%) trials possessed all the required data and were included in our analysis. The most common excluded condition of our interest was brain metastases (60.8%), followed by HIV positivity (46.4%), HBV/HCV positivity (46.0%), and concurrent malignancies (15.5%). Additionally, 50.9% of clinical trials only included patients with ECOG PS 0 to 1. HIV and HBV/HCV infection were exclusion criteria of 22 (80.8%) and 19 (73.1%) immunotherapy trials, respectively.

CONCLUSION

Patients with brain metastases, prior or concurrent malignancies, HIV infection, HBV/HCV infection, or low-functioning PS were overly restricted from participating in advanced prostate clinical trials. Advocating for broader criteria may ameliorate generalizability.

Prognostic impact of the presence or absence of prior cancer in patients with cancer using cure models: A population-based study

Developing a subsequent cancer is one of the major concerns for cancer survivors; however, whether prior cancer could affect their prognosis is unknown. We therefore aimed to analyze how prognosis varies depending on prior cancer in patients with newly developed cancer, focusing on cancer that had been "cured." We used the record-linked database of the Osaka Cancer Registry and Vital Statistics to select 186,798 patients with stomach, colorectal, or lung cancer aged ≥40 years from 1995 to 2009 in Osaka, Japan. These cancers were defined as index cancers. We classified the patients into two groups according to whether they had a prior cancer diagnosis within 10 years before the index cancer diagnosis. The cured proportion was defined as the proportion of cancer patients with the same mortality as the general population and was estimated using the parametric mixture cure model. The cured proportion of patients with prior cancer by sex and age group was not significantly lower than those without prior cancer, except for patients with stomach cancer aged ≥65 years. According to the index cancer stage in the localized stomach or colorectal cancer, the cured proportion in patients with prior cancer was lower than in those without prior cancer. However, at any stage of lung cancer, the proportion of patients with prior cancer who had been cured was similar to patients without prior cancer, therefore prior cancer had a prognostic impact only in some patient groups based on the characteristics of their index cancer.

Clinical characteristics analysis and prognostic nomogram for predicting survival in patients with second primary prostate cancer: a population study based on SEER database

BACKGROUND AND AIMS

Second primary prostate cancer (SPPCa) is a common type of secondary malignancy that negatively impacts patient prognosis. This study aimed to identify prognostic factors for SPPCa patients and develop nomograms to assess their prognosis.

METHODS

Patients diagnosed with SPPCa between 2010 and 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The study cohort was randomly divided into a training set and a validation set. Cox regression analysis, Kaplan‒Meier survival analysis, and least absolute shrinkage and selection operator regression analysis were used to identify independent prognostic factors and develop the nomogram. The nomograms were evaluated using the concordance index (C-index), calibration curve, area under the curve (AUC), and Kaplan-Meier analysis.

RESULTS

A total of 5342 SPPCa patients were included in the study. Independent prognostic factors for overall survival (OS) and cancer-specific survival (CSS) were identified as age, interval between diagnoses, first primary tumor site, and AJCC stage, N stage, M stage, PSA, Gleason score, and SPPCa surgery. Nomograms were constructed based on these prognostic factors, and the performance was evaluated using the C-index (OS: 0.733, CSS: 0.838), AUC, calibration curve, and Kaplan-Meier analysis, which demonstrated excellent predictive accuracy.

CONCLUSION

We successfully established and validated nomograms to predict OS and CSS in SPPCa patients using the SEER database. These nomograms provide an effective tool for risk stratification and prognosis assessment in SPPCa patients, which will aid clinicians in optimizing treatment strategies for this patient population.

Prognosis of male lung cancer patients with urinary cancer: a study from a national population-based analysis

Lung cancer accounts for the most cancer-related deaths in the world. Our previous study suggested the improved survival of lung cancer patients, mainly female patients, with subsequent metachronous primary breast cancer. However, whether the survival advantages of the two primaries are associated with patients' sex and the specific breast cancer is unclear. Whether male lung cancer patients with another primary may encounter the same survival advantage as female patients is also uncertain. The uncertainty hinders these patients from the potential benefit of lung cancer clinical trial. A total of 343 male lung adenocarcinoma patients with subsequent bladder papillary transitional cell carcinoma (LCBC), 1539 lung adenocarcinoma patients with prior bladder papillary transitional cell carcinoma (BCLC), 1181 lung adenocarcinoma patients with subsequent prostate adenocarcinoma (LCPC), 7426 lung adenocarcinoma patients with prior prostate adenocarcinoma (PCLC), and patients with single bladder/prostate/lung (SLC) cancer were identified from the Surveillance, Epidemiology, and End Results. Patients were classified into simultaneous two primary cancer (sTPC), metachronous two primary cancer 1 (mTPC1), or mTPC2 groups when interval time between two cancers was within 6 months, between 7 and 60 months, or over 60 months, respectively. Propensity matching score program was executed to match the two primary cancers with single primary. Cox regression and competing risk regression were performed to identify confounders associated with all-cause and cancer-specific survival, respectively. The major cancer-related and non-cancer-related death in the two primaries were lung cancer and heart disease, respectively. Median overall survival times since lung primary of LCBC and SLC were 97 and 17 months, respectively, and incidence of all-cause and cancer-specific death in LCBC since lung malignancy was significantly lower (Coef. - 1.24, 95% CI - 1.49 to 0.99; SHR 0.42, 95% CI 0.33-0.53). Among the categorized groups, prognosis values of sTPC and mTPC2 groups were not statically different from that of the matched single lung cancer, whereas increased overall survival time and decreased incidence of all-cause and cancer-specific death relative to the matched patients were observed in mTPC1 group (H.R 0.28, 95% CI 0.19-0.41; SHR 0.33, 95% CI 0.23-0.47). Similar prognosis of LCPC relative to SLC was also observed. Furthermore, a generally improved survival relative to SLC was observed in PCLC (median survival times of PCLC and SLC were 17 and 12 months, respectively; Coef. - 0.32, 95% CI - 0.43 to 0.22; SHR 0.77, 95% CI 0.69-0.85), whereas prognosis of BCLC was similar to the matched ones. These results hinted that survival of lung cancer patients might vary with prior cancer history. Further analysis among groups with the two primaries suggested that advanced bladder cancer was not associated with prognosis of patients with LCBC and BCLC. On the contrary, advanced prostate cancer was associated with all-cause and cancer-specific death in patients with PCLC but not in patients with LCPC. Compared with patients with single lung cancer, male lung cancer patients with subsequent bladder/prostate primary over 6 months experienced generally improved survival. These results were similar to our previous study regarding female lung cancer patients with another breast primary. On the contrary, male lung cancer patients with prior primary malignancy encountered varied prognosis: improved survival relative to single lung primary was observed in lung cancer with prior prostate cancer, whereas prognosis of lung cancer with prior bladder cancer was not different. Therefore, great attention was required to characterize prognosis of lung cancer patients with another primary in advance, which was essential to eliminate the potential bias when these patients were included into the clinical trials.

Effect of prior thyroid cancer on survival of primary liver cancer: a study based on the SEER database

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.