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. 2017 Jun 26;12(6):e0179784.
doi: 10.1371/journal.pone.0179784. eCollection 2017.

Clinical characteristics of second primary pancreatic cancer

Jung Hyun Jo  1 , In Rae Cho  1 , Jang Han Jung  1 , Hee Seung Lee  1 , Moon Jae Chung  1 , Seungmin Bang  1 , Seung Woo Park  1 , Jae Bock Chung  1 , Si Young Song  1 , Jeong Youp Park  1
Affiliations

Clinical characteristics of second primary pancreatic cancer

Jung Hyun Jo et al. PLoS One. .

Abstract

Purpose: Several studies reported the increased risk of second primary pancreatic ductal adenocarcinoma (2nd PDAC) in cancer survivors. However, data on the characteristics of 2nd PDAC are insufficient.

Methods: This retrospective cohort study included 1759 patients with PDAC. They were classified as having 2nd PDAC or first primary PDAC (1st PDAC) according to a prior diagnosed cancer of different origin, at least 6 months before PDAC diagnosis.

Results: There were 110 patients (6.4%) with 2nd PDAC and 1606 (93.6%) patients with 1st PDAC. Patients with 2nd PDAC presented with older age (66.5 vs. 62.2 years, p < 0.001) and higher rate of resectability (26.4% vs. 15.9%, p = 0.004) at diagnosis than those with 1st PDAC. Multivariate analysis without considering resectable status showed that 2nd PDAC (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.56-0.94, p = 0.016) was associated with better overall survival. After adjusting for resectable status, however, 2nd PDAC (HR 0.85, 95% CI 0.66-1.09, p = 0.198) was no longer associated with overall survival. When subgroups were separately analyzed according to initial treatment modality, the effectiveness of surgery and chemotherapy were similar between 2nd and 1st PDAC (33.1 vs. 28.5 months, p = 0.860 and 10.8 vs. 10.7 months, p = 0.952).

Conclusions: The proportion of resectable cases was significantly higher in 2nd PDAC. When surgery with curative aim was possible, the overall survival was increased even in patients with 2nd PDAC. These results suggest the importance of screening for second primary cancer in cancer survivors.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier analysis of overall survival (OS) according to subgroup.
(A) First primary pancreatic ductal adenocarcinoma (1st PDAC) vs. second primary PDAC (2nd PDAC) in the whole cohort (n: 1606 vs. 110): median OS 11.8 vs. 12.3 months, p = 0.068 by log-rank test. (B) 1st PDAC vs. 2nd PDAC in patients who received curative surgery as initial treatment (n: 256 vs. 29): median OS 28.5 vs. 33.1 months, p = 0.860 by log-rank test. (C) 1st PDAC vs. 2nd PDAC in patients who received chemotherapy as initial treatment (n: 1094 vs. 66): median OS 10.7 vs. 10.8 months, p = 0.952 by log-rank test.
Fig 2
Fig 2. Cumulative curve of diagnosis of second pancreatic ductal adenocarcinoma (PDAC).
Cumulative incidence rate of second primary PDAC (2nd PDAC) after the diagnosis of prior cancer in the 2nd PDAC group. The median interval between the diagnosis of the 2nd PDAC and the diagnosis of the prior cancer was 8.4 years. The cumulative rates (cumulative cases for every 5 years after the diagnosis of prior cancer) are presented as a table.
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