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Dadey DYA, Medress ZA, Sharma M, Ugiliweneza B, Wang D, Rodrigues A, Parker J, Burton E, Williams B, Han SS, Boakye M, Skirboll S. Risk of developing glioblastoma following non-CNS primary cancer: a SEER analysis between 2000 and 2018. J Neurooncol 2023; 164:655-662. [PMID: 37792220 DOI: 10.1007/s11060-023-04460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Patients with a prior malignancy are at elevated risk of developing subsequent primary malignancies (SPMs). However, the risk of developing subsequent primary glioblastoma (SPGBM) in patients with a prior cancer history is poorly understood. METHODS We used the Surveillance, Epidemiology, and End Results (SEER) database and identified patients diagnosed with non-CNS malignancy between 2000 and 2018. We calculated a modified standardized incidence ratio (M-SIR), defined as the ratio of the incidence of SPGBM among patients with initial non-CNS malignancy to the incidence of GBM in the general population, stratified by sex latency, and initial tumor location. RESULTS Of the 5,326,172 patients diagnosed with a primary non-CNS malignancy, 3559 patients developed SPGBM (0.07%). Among patients with SPGBM, 2312 (65.0%) were men, compared to 2,706,933 (50.8%) men in the total primary non-CNS malignancy cohort. The median age at diagnosis of SPGBM was 65 years. The mean latency between a prior non-CNS malignancy and developing a SPGBM was 67.3 months (interquartile range [IQR] 27-100). Overall, patients with a primary non-CNS malignancy had a significantly elevated M-SIR (1.13, 95% CI 1.09-1.16), with a 13% increased incidence of SPGBM when compared to the incidence of developing GBM in the age-matched general population. When stratified by non-CNS tumor location, patients diagnosed with primary melanoma, lymphoma, prostate, breast, renal, or endocrine malignancies had a higher M-SIR (M-SIR ranges: 1.09-2.15). Patients with lung cancers (M-SIR 0.82, 95% CI 0.68-0.99), or stomach cancers (M-SIR 0.47, 95% CI 0.24-0.82) demonstrated a lower M-SIR. CONCLUSION Patients with a history of prior non-CNS malignancy are at an overall increased risk of developing SPGBM relative to the incidence of developing GBM in the general population. However, the incidence of SPGBM after prior non-CNS malignancy varies by primary tumor location, with some non-CNS malignancies demonstrating either increased or decreased predisposition for SPGBM depending on tumor origin. These findings merit future investigation into whether these relationships represent treatment effects or a previously unknown shared predisposition for glioblastoma and non-CNS malignancy.
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Affiliation(s)
- David Y A Dadey
- Department of Neurosurgery, Stanford University, Stanford, CA, 94301, USA.
| | - Zachary A Medress
- Department of Neurosurgery, Stanford University, Stanford, CA, 94301, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, KY, 40202, USA
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, KY, 40202, USA
| | - Adrian Rodrigues
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jonathon Parker
- Department of Neurosurgery, Mayo Clinic, Scottsdale, AZ, 85259, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | - Brian Williams
- Department of Neurosurgery, University of Louisville, Louisville, KY, 40202, USA
| | - Summer S Han
- Department of Neurosurgery, Stanford University, Stanford, CA, 94301, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, KY, 40202, USA
| | - Stephen Skirboll
- Department of Neurosurgery, Stanford University, Stanford, CA, 94301, USA
- Department of Surgery, Palo Alto Veterans Affairs, Palo Alto, CA, 94304, USA
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Ding X, Yang X, Hao Q, Xu F, Yu X, Rao L, Yuan C, Tian S. Risk prediction of second primary malignancies in primary colorectal neuroendocrine neoplasms patients: a population-based study. J Endocrinol Invest 2023:10.1007/s40618-023-02047-x. [PMID: 36870016 DOI: 10.1007/s40618-023-02047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE In this study, we aimed to identify risk factors for developing second primary malignancies (SPMs) in colorectal neuroendocrine neoplasms (NENs) patients and develop a competing-risk nomogram to predict SPMs' probabilities quantitatively. METHODS Patients with colorectal NENs were retrospectively collected from the Surveillance, Epidemiology, and End Results (SEER) database during 2000-2013. Potential risk factors for SPMs' occurrence in colorectal NENs' patients were identified by the Fine and Gray's proportional sub-distribution hazards model. Then, a competing-risk nomogram was constructed to quantify SPMs' probabilities. The discriminative abilities and calibrations of this competing-risk nomogram were assessed by the area under the receiver-operating characteristic (ROC) curves (AUC) and calibration curves. RESULTS We identified 11,017 colorectal NENs' patients, and randomly divided them into training (n = 7711 patients) and validation (n = 3306 patients) cohorts. In the whole cohort, 12.4% patients (n = 1369) had developed SPMs during the maximum follow-up of approximately 19 years (median 8.9 years). Sex, age, race, primary tumor location, and chemotherapy were identified as risk factors for SPMs' occurrence in colorectal NENs' patients. Such factors were selected to develop a competing-risk nomogram and showed excellent predictive ability for SPMs' occurrence (the 3-, 5-, and 10-year AUC values were 0.631, 0.632, and 0.629 in the training cohort and 0.665, 0.639, 0.624 in the validation cohort, respectively). CONCLUSIONS This research identified risk factors for SPMs' occurrence in colorectal NENs' patients. Competing-risk nomogram was constructed and proved to have good performance.
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Affiliation(s)
- X Ding
- Department of Clinical Laboratory, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, People's Republic of China
| | - X Yang
- Department of Clinical Laboratory, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, People's Republic of China
| | - Q Hao
- Department of Nursing, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, People's Republic of China
| | - F Xu
- Department of Pharmacy, The People's Hospital of China Three Gorges University, Yichang, 443000, People's Republic of China
| | - X Yu
- College of Basic Medical Science, China Three Gorges University, Yichang, 443002, People's Republic of China
| | - L Rao
- Department of Clinical Laboratory, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, People's Republic of China
| | - C Yuan
- College of Basic Medical Science, China Three Gorges University, Yichang, 443002, People's Republic of China.
| | - S Tian
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.
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Loharkar S, Basu S. Metachronous Adenocarcinoma of the Lung in the Setting of Metastatic Gastric Neuroendocrine Tumor: Value of Elucidating Discordance on Dual-Tracer PET/CT with Ki-67 Index. J Nucl Med Technol 2023; 51:75-77. [PMID: 35440472 DOI: 10.2967/jnmt.121.263415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Dual-tracer PET/CT (18F-FDG and 68Ga-DOTATATE) has become established practice in the management of metastatic neuroendocrine neoplasms (NENs) and has demonstrated the advantages to patient management of deciphering the molecular PET characteristics of the tumor. Judicious elucidation of the findings is important, especially in scenarios of discordance with reported histopathology, potentially leading to an unsuspected diagnosis such as second primary malignancies. Such a diagnosis established early in the disease course, and mostly at an asymptomatic stage, provides lead time for timely, appropriate management. This concept was elaborated in a case of incidentally detected 18F-FDG-avid metachronous lung adenocarcinoma in a patient with metastatic, well-differentiated gastric NEN, wherein dual-tracer PET/CT showed 18F-FDG-avid but not 68Ga-DOTATATE-avid lung opacity.
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Affiliation(s)
- Sarvesh Loharkar
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, and Homi Bhabha National Institute, Mumbai, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, and Homi Bhabha National Institute, Mumbai, India
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Coelho S, Costa C, Santos AP, Souteiro P, Oliveira J, Oliveira J, Azevedo I, Torres I, Bento MJ. Pancreatic neuroendocrine neoplasms: survival trend analysis of a comprehensive center. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:32-41. [PMID: 37435456 PMCID: PMC10259287 DOI: 10.1530/eo-22-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 07/13/2023]
Abstract
Objectives Therapeutic options for pancreatic neuroendocrine neoplasia (Pan-NEN) have increased over the last decade. We aim to understand the evolution of the prognosis of patients with diagnosis of Pan-NEN within a 12-year period, considering the implementation of new treatments. Methods This study is a retrospective cohort study of patients diagnosed with Pan-NENs between 2006 and 2017. Survival outcome estimates were calculated by Kaplan-Meier method. The impact of baseline clinicopathological characteristics on survival was explored with the use of Cox proportional hazard model. Results Of the 97 patients, 77 (79.9%) had well-differentiated neuroendocrine tumor (NET) according to WHO 2010 classification, and 52 (53.6%) had localized or locoregional disease. There were no differences between clinicopathological characteristics and survival outcomes when comparing patients diagnosed between 2006-2011 and 2012-2017. Neuroendocrine carcinoma - HR 2.76, 95% CI 1.17-6.55 - and stages III and IV at diagnosis were independent poor prognostic factors - HR 6.02, 95% CI 2.22-16.33 and HR 6.93, 95% CI 2.94-16.32, respectively. Conclusions The new therapeutic approaches did not induce better survival outcomes on Pan-NEN in recent years. This is possibly due to the indolent nature of NET grades 1 and 2, even metastatic, allowing patients to be submitted to new target therapies along their disease course.
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Affiliation(s)
- Sara Coelho
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Cláudia Costa
- Department of Endocrinology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Ana Paula Santos
- Department of Endocrinology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
- Research Center, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Pedro Souteiro
- Department of Endocrinology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Joana Oliveira
- Department of Endocrinology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Júlio Oliveira
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Isabel Azevedo
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Isabel Torres
- Department of Endocrinology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
| | - Maria José Bento
- Department of Epidemiology, Portuguese Oncology Institute of Porto, EPE, Porto, Portugal
- School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Lancellotti F, Solinas L, Telesco D, Sagnotta A, Belardi A, Balsamo G, Mancini S. A rare case of metachronous neuroendocrine tumor after a colorectal adenocarcinoma: qualitative critical review of synchronous and metachronous gastrointestinal NET. Clin J Gastroenterol 2021; 14:115-122. [PMID: 33044637 PMCID: PMC7886727 DOI: 10.1007/s12328-020-01255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/19/2020] [Indexed: 01/17/2023]
Abstract
Gastrointestinal neuroendocrine tumor (NET) associated with a metachronous intestinal adenocarcinoma is rare. We report the case of a 71-year-old man with an ileal NET. Patient has previously undergone a left colectomy for sigmoid cancer. We report a complete review both of the metachronous and synchronous NET. A comprehensive systematic literature search in PubMed, EMBASE, and MEDLINE identified a total of 35 relevant studies. This study includes an analysis of review articles, case reports, case series, retrospective studies and population-based studies. In the English literature to date, there are 21 case reports (19 synchronous cases and 2 metachronous cases), 3 case series and 3 review articles, and less than 10 retrospective studies or population-based studies. A total of 31 patients in 24 articles were included in the study: 28 patients with a synchronous gastrointestinal NET and colorectal adenocarcinoma and 3 patients with metachronous gastrointestinal NET and colorectal adenocarcinoma. The incidence of synchronous cancer (particularly for colorectal and gastric cancer) with a gastrointestinal NET ranges from 10 to 50%, while for the metachronous ones it is still unclear. This is the third metachronous case report and the first descriptive case of gastrointestinal NET diagnosed 2 years after a colorectal adenocarcinoma. An endoscopic follow-up program for gastrointestinal NET patients and/or for first-degree relatives of NET patients appears recommendable.
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Affiliation(s)
| | - Luigi Solinas
- Department of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome, Italy
| | - Davide Telesco
- Department of General Surgery, Surgical Specialities “Paride Stefanini”, Sapienza University of Rome, Rome, Italy
| | - Andrea Sagnotta
- Department of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome, Italy
| | - Augusto Belardi
- Department of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome, Italy
| | - Giuseppina Balsamo
- Department of Clinical Pathology, San Filippo Neri Hospital, Rome, Italy
| | - Stefano Mancini
- Department of General Surgery and Surgical Oncology, San Filippo Neri Hospital, Rome, Italy
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Paleń-Tytko JE, Przybylik-Mazurek EM, Rzepka EJ, Pach DM, Sowa-Staszczak AS, Gilis-Januszewska A, Hubalewska-Dydejczyk AB. Ectopic ACTH syndrome of different origin-Diagnostic approach and clinical outcome. Experience of one Clinical Centre. PLoS One 2020; 15:e0242679. [PMID: 33237923 PMCID: PMC7688153 DOI: 10.1371/journal.pone.0242679] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Ectopic Cushing Syndrome (EAS) is a rare condition responsible for about 5–20% of all Cushing syndrome cases. It increases the mortality of affected patients thus finding and removal of the ACTH-producing source allows for curing or reduction of symptoms and serum cortisol levels. The aim of this study is to present a 20-year experience in the diagnosis and clinical course of patients with EAS in a single Clinical Centre in Southern Poland as well as a comparison of clinical course and outcomes depending on the source of ectopic ACTH production–especially neuroendocrine tumors with other neoplasms. Methods Twenty-four patients were involved in the clinical study with EAS diagnosed at the Department of Endocrinology between years 2000 and 2018. The diagnosis of EAS was based on the clinical presentation, hypercortisolemia with high ACTH levels, high dose dexamethasone suppression test and/or corticotropin-releasing hormone tests. To find the source of ACTH various imaging studies were performed. Results Half of the patients were diagnosed with neuroendocrine tumors, whereby muscle weakness was the leading symptom. Typical cushingoid appearance was seen in merely a few patients, and weight loss was more common than weight gain. Patients with neuroendocrine tumors had significantly higher midnight cortisol levels than the rest of the group. Among patients with infections, we observed a significantly higher concentrations of cortisol 2400 levels in gastroenteropancreatic neuroendocrine tumors. Chromogranin A correlated significantly with potassium in patients with neuroendocrine tumors and there was a significant correlation between ACTH level and severity of hypokalemia. Conclusion EAS is not common, but if it occurs it increases the mortality of patients; therefore, it should be taken into consideration in the case of coexistence of severe hypokalemia with hypertension and muscle weakness, especially when weight loss occurs. Because the diagnosis of gastroenteropancreatic neuroendocrine tumor worsens the prognosis-special attention should be paid to these patients.
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Multiple liver metastases originating from synchronous double cancer of neuroendocrine tumor and rectal cancer: a case report. Surg Case Rep 2020; 6:36. [PMID: 32056066 PMCID: PMC7018860 DOI: 10.1186/s40792-020-0800-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Neuroendocrine tumor (NET) is a relatively rare tumor and can develop in almost any organ, but primary mesenteric NETs are extremely rare. In addition, liver metastases from synchronous double cancer of neuroendocrine tumor graded as G1 and second primary malignancies (SPMs) have never been reported before. We herein report a case of multiple liver metastases from synchronous double cancer of NET (G1) at the ileal mesentery and rectal cancer. Case presentation A 66-year-old man was identified as having tumors in the rectum and the ileal mesentery by computed tomography (CT). He underwent laparoscopic low anterior resection for rectal cancer and biopsy of the ileal mesentery lymph node and was diagnosed with rectal cancer as pT3 pN1 cM0 (stage IIIB) and NET (G1) of the ileal mesentery. He received oxaliplatin and capecitabine (XELOX) for 3 months as adjuvant chemotherapy for rectal cancer. The NET (G1) of the ileal mesentery was low grade and had not expanded at follow-up. A CT scan performed 4 years after the surgery indicated multiple liver metastases. All the metastases had the same findings on CT and magnetic resonance imaging (MRI). Thus, the patient underwent the first stage of modified associating liver partition and portal vein ligation for staged hepatectomy (modified ALPPS), comprising partial hepatectomies of segments 3 and 4, ligation of the right branch of portal vein, and hepatic partition on the demarcation line, followed by the second stage of modified ALPPS (right lobectomy). Histopathological findings revealed that the 14 nodules were metastatic liver tumors of rectal cancer and the 2 nodules were liver metastases of the NET (G1). Conclusions Our findings suggest that synchronous double cancer of NET and gastrointestinal cancer may be indistinguishable in preoperative images. However, curative resection, precise pathological diagnosis, and adequately adjusted treatment may result in a better prognosis.
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Verrico M, Rossi L, Tomao S, Colonna M, Vici P, Tomao F. Metachronous and Synchronous Cancers in Patients with Neuroendocrine Tumors. Oncology 2019; 98:10-15. [PMID: 31505502 DOI: 10.1159/000502384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/28/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neuroendocrine tumors (NETs) are a heterogeneous group of malignancies with various clinical presentations and growth rates. NET incidence has been estimated to 2.5-5 per 100,000 people per year, and NET prevalence is 35 per 100,000. They are frequently associated with synchronous or metachronous second primary malignancies (SPM). METHODS We retrospectively reviewed our institutional database on NET patients. We report on 30 patients with NETs and SPMs from a series of 262 patients with NETs: 10 patients with synchronous NETs (33.3%) and 20 with metachronous SPMs (66.6%). RESULTS The median patient age was 67 years. Of the 10 synchronous lesions, 50% were observed in the GI tract. The most common locations of these lesions were the colon (15%) and pancreas (25%). In 2 patients, there was an association of prostate neoplasia with a subsequent NET of the pancreas. CONCLUSIONS Only few studies have examined the association between NETs and SPMs. Our study showed that the risk of second cancer following NETs is increased. In this single-institution retrospective review, our incidence of additional malignancies in patients with NET was 11.4%.
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Affiliation(s)
- Monica Verrico
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Aprilia, Italy
| | - Luigi Rossi
- Oncology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Aprilia, Italy,
| | - Silverio Tomao
- Division of Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Consorzio Interuniversitario per la Bio-Oncologia (CINBO), Chieti, Italy
| | - Maria Colonna
- Oncology Unit, A. Fiorini Hospital, Terracina, Italy
| | - Patrizia Vici
- Medical Oncology, National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Dipartimento Materno Infantile e Scienze Urologiche, Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
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Pirozzi A, Riccardi F, Arpino G, Mocerino C, Campione S, Molino C, Cartenì G. Occurrence of second primary malignancies in patients with neuroendocrine tumors of the digestive tract: A case report. Medicine (Baltimore) 2019; 98:e16508. [PMID: 31335724 PMCID: PMC6708809 DOI: 10.1097/md.0000000000016508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE There is an association between the presence of neuroendocrine neoplasms and incremented risk to develop second primary malignancies. This risk is estimated to be 17%. The most common secondary neoplasms were found in the Gastrointestinal and Genitourinary tracts. PATIENT CONCERNS A 74-year-old Caucasian patient with melaena came to our observation in June 2015. The Esophago-gastro-duodenoscopy exam found a polypoid formation in the duodenal bulb. Histopathological examination showed a well-differentiated neuroendocrine neoplasm (G1). DIAGNOSIS During the follow up for the neuroendocrine neoplasm, a CT scan was performed in August 2016 describing infiltration of the right renal sinus and the third proximal ureter segment with heterogeneous enhancement of vascular structure. An US-guided biopsy was conclusive for a Diffuse Large B Cell Lymphoma. In October 2016, a colonoscopy showed a neoplastic lesion at 20 cm from the anal orifice. The Histology exam was positive for an adenocarcinoma with a desmoplastic stroma infiltration. INTERVENTIONS In November 2016, the patient underwent a left hemicolectomy: the pathologic staging described a G2 adenocarcinoma pT3N1b. In May 2018, the Octreotide scan was negative. In the same month, the patient started a treatment based on 6 cycles of Rituximab, Oxaliplatin, and Capecitabine due to the persistence of lymphomatous disease and hepatic metastases. In July 2018, other 3 cycles of the same treatment were scheduled. OUTCOMES In January 2019, due to an increase in liver metastases' size, it was decided to start a new regimen for the colon cancer with FOLFIRI+Cetuximab. The patient is still in treatment with this regimen in April 2019. LESSONS The risk of a second primary tumor is increased among patients older than 70. Therefore, it is necessary to follow them using total body CT scan and endoscopic techniques of gastrointestinal and genitourinary tracts, not only for the evaluation of the neuroendocrine tumor but also for the higher risk to develop other neoplastic diseases.
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Affiliation(s)
- Angelo Pirozzi
- Department of Clinical Medicine and Surgery, University of Naples Federico II
| | | | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Carmela Mocerino
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria
| | | | - Carlo Molino
- Azienda Ospedaliero-Universitaria, Naples, Italy
| | - Giacomo Cartenì
- Department of Medical Oncology, Azienda Ospedaliero-Universitaria
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Broman KK, Bailey CE, Parikh AA. Sidedness of Colorectal Cancer Impacts Risk of Second Primary Gastrointestinal Malignancy. Ann Surg Oncol 2019; 26:2037-2043. [PMID: 30949861 DOI: 10.1245/s10434-019-07326-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Indexed: 01/09/2023]
Abstract
INTRODUCTION A history of colorectal cancer (CRC) increases the risk of subsequent gastrointestinal (GI) cancer. Cancers of the right colon, left colon, and rectum differ according to molecular profiles, responses to treatment, and outcomes. OBJECTIVE The purpose of this study was to determine if CRC location is associated with differential risk for secondary primary GI malignancy. METHODS A retrospective cohort of adults with CRC was compiled using the Surveillance, Epidemiology, and End Results database (1973-2015). Standardized incidence ratios (SIRs) for second primary GI malignancies were compared based on location of the index CRC (right colon, left colon, or rectum). RESULTS The cohort included 281,413 adults with CRC (30.3% right, 35.3% left, 34.3% rectum). With a median 4.9-year follow-up, 12,064 (4.3%) patients developed a second primary GI malignancy (64% CRC, 36% non-CRC). Those with CRC at any location had higher than expected incidences of small intestine, bile duct, and other CRCs, and lower incidences of liver and gallbladder cancer. The SIR for small intestinal cancer was higher after right colon cancer than after left colon or rectal cancer. The esophageal cancer SIR was higher after left colon cancer. Pancreas cancer was higher than expected for right colon cancer, but lower for left colon and rectal cancer. CONCLUSION The location of CRC leads to differences in the incidence and location of second primary GI malignancies and may be related to similarities in the associated carcinogenesis and molecular pathways or response to treatment. CRC location not only impacts treatment response and outcomes, but should also be considered during subsequent surveillance.
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Affiliation(s)
- Kristy K Broman
- Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina E Bailey
- Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander A Parikh
- Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC, USA.
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Marital status is an independent prognostic factor for pancreatic neuroendocrine tumors patients: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database. Clin Res Hepatol Gastroenterol 2017; 41:476-486. [PMID: 28416359 DOI: 10.1016/j.clinre.2017.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/08/2017] [Accepted: 02/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Marital status's prognostic impact on pancreatic neuroendocrine tumors (PNET) has not been rigorously studied. We aimed to explore the relationship between marital status and outcomes of PNET. METHODS We retrospectively investigated 2060 PNET cases between 2004 and 2010 from Surveillance, Epidemiology, and End Results (SEER) database. Variables were compared by Chi2 test, t-test as appropriate. Kaplan-Meier methods and COX proportional hazard models were used to ascertain independent prognostic factors. RESULTS Married patients had better 5-year overall survival (OS) (53.37% vs. 42.27%, P<0.001) and 5-year pancreatic neuroendocrine tumor specific survival (PNSS) (67.76% vs. 59.82%, P=0.001) comparing with unmarried patients. Multivariate analysis revealed marital status is an independent prognostic factor, with married patients showing better OS (HR=0.74; 95% CI: 0.65-0.84; P<0.001) and PNSS (HR=0.78; 95% CI: 0.66-0.92; P=0.004). Subgroup analysis suggested marital status plays a more important role in the PNET patients with distant stage rather than regional or localized disease. CONCLUSIONS Marital status is an independent prognostic factor for survival in PNET patients. Poor prognosis in unmarried patients may be associated with a delayed diagnosis with advanced tumor stage, psychosocial and socioeconomic factors. Further studies are needed.
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Mao R, Chen T, Zhou F, Jiang W, Yang X, Ai Z, Li M, Qin L, Wang L, Fei K, Chen C. The burdens of lung cancer involved multiple primary cancers and its occurring patterns-SEER Analysis between 1973 and 2006. Sci Rep 2017; 7:6451. [PMID: 28743940 PMCID: PMC5527071 DOI: 10.1038/s41598-017-06763-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/19/2017] [Indexed: 11/09/2022] Open
Abstract
The prognosis of malignancies has improved in recent years, subsequent primary cancers (SPCs) have become more frequent. This study investigates the patterns of lung cancer involved multiple primary cancers. We enrolled 206,619 primary lung cancer patients and 2,071,922 patients with other primary malignancies from Surveillance, Epidemiology and End Results (SEER) database. Observed annual risk (OAR) and absolute numbers were used to describe the risk of SPC and observed cases of SPC per 10,000 person-years at risk. Overall, OAR of SPCs following lung cancer was 176.28. At follow-up, 41.26% of SPCs occurred within 12-59 months while the highest OAR appeared after 120 months. The overall OAR of subsequent lung cancer after other malignancies was 27.90. Overall, the highest OAR and the highest absolute numbers of subsequent lung cancers were noticed 60-119 months and over 120 months post-diagnosis, respectively. Ten related cancers were listed. Our findings encourage surveillance for 10 common SPCs in lung cancer survivors during follow-up as well as screening for lung cancer after 10 common malignancies.
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Affiliation(s)
- Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Fangyu Zhou
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Weili Jiang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, PR China
- Key Laboratory of Public Health Safety (Ministry of Education), Shanghai, PR China
| | - Xiaorong Yang
- Department of Epidemiology and Biostatistics, Shandong University, Shandong, PR China
| | - Zisheng Ai
- Department of Medical Statistics, TongJi University School of Medicine, Shanghai, PR China
| | - Mu Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Linlin Qin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Long Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China.
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, PR China.
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