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. 2020 Jan 23:12:105-112.
doi: 10.2147/CLEP.S230149. eCollection 2020.

Second Primary Cancers in Melanoma Patients Critically Shorten Survival

Guoqiao Zheng  1   2 , Subhayan Chattopadhyay  1   2 , Kristina Sundquist  3   4   5   6 , Jan Sundquist  3   4   5   6 , Asta Försti  1   3 , Akseli Hemminki  7   8 , Kari Hemminki  1   3   9
Affiliations

Second Primary Cancers in Melanoma Patients Critically Shorten Survival

Guoqiao Zheng et al. Clin Epidemiol. .

Abstract

Background: Survival in malignant cutaneous melanoma has improved but increasing survival will result in an increased likelihood of the occurrence of second primary cancers (SPCs). SPCs may adversely interfere with survival. We quantified survival in patients with different types of SPCs, in comparison to known poor prognostic indicators of metastatic disease.

Methods: Data for melanoma and any SPCs were obtained from the Swedish Cancer Registry for years 2003 through 2015, including clinical TNM classification. SPCs were grouped into three 'prognostic groups' based on 5-year relative survival of these cancers as first primary cancer. Kaplan-Meier survival curves were generated and hazard ratios were estimated using Cox regression, adjusted for a number of variables and treating diagnosis of SPC as a time-dependent variable.

Results: The total number of first melanoma patients was 28,716 followed by 3,202 (11.1%) SPCs, 1/3 of which had a second melanoma while 2/3 had other SPCs. Among men diagnosed at age over 70 years, who survived at least 10 years, 31.4% had SPC. HRs (95% CI) for survival increased systematically from the reference rate of 1.00 (no SPC) to 1.59 (1.35-1.87) with SPC of good prognosis (78.6% of SPCs) to 3.49 (2.58-4.72) of moderate prognosis (12.0%) and to 7.93 (5.50-11.44) of poor prognosis (9.4%). In patients without SPC, the HRs increased to 2.62 (2.02-3.39) with any nodal metastases and to 5.88 (4.57-7.57) with any distant metastases compared to patients without local or distant metastases.

Conclusion: The data showed that SPCs are an increasingly common negative prognostic factor for melanoma. Future attempts to improve melanoma survival need to target SPCs.

Keywords: melanoma; metastasis; prognosis; second cancer; survival.

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Conflict of interest statement

A.H. is shareholder in Targovax ASA. A.H. is an employee and shareholder in TILT Biotherapeutics Ltd. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Survival probability after first melanoma diagnosis in patients without SPC, with second melanoma and with non-melanoma SPC. *Last cancer was melanoma for patients during the time with one single melanoma, and was SPC for those from the time with SPC. Abbreviation: SPC, second primary cancer.
Figure 2
Figure 2
Survival probability after first melanoma diagnosis in patients without SPC and with SPC of good, moderate and poor prognosis. *Last cancer was melanoma for patients during the time with one single melanoma, and was SPC for those from the time with SPC. Abbreviation: SPC, second primary cancer.
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