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. 2020 May;8(10):638.
doi: 10.21037/atm-20-2059.

Second primary malignancies among cancer patients

Xuanqi Zheng  1 , Xiao Li  2 , Minqi Wang  3 , Jianfei Shen  4 , Giovanni Sisti  5 , Zelai He  6 , Jinfeng Huang  1 , Yan Michael Li  7 , Aimin Wu  1 ; Multidisciplinary Oncology Research Collaborative Group (MORCG)
Affiliations

Second primary malignancies among cancer patients

Xuanqi Zheng et al. Ann Transl Med. 2020 May.

Abstract

Background: Rate of second primary malignancies (SPM) is steadily increasing over the last decades. New therapies, early diagnostic markers, screening tests for a larger number of individuals contribute to the increase prevalence of SPM. In the current study, we try to described the demographic composition of SPM victims, distribution of primary sites, and the impact of related factors on prognosis.

Methods: We conducted a retrospective study identifying patients over the age of 18 who were diagnosed with SPM from the 16 most common cancer sites between 2000 and 2013 from Surveillance, Epidemiology, and End Results data. Cox proportional hazards regression was used to analyze the relationship between different factors associated to the prognosis of SPM. Standard incidence rate of multiple primary (MP-SIR) was also calculated.

Results: A total of 303,753 patients were diagnosis with SPM and 76,168 of whom (25.08%) were included in our analytic cohort. Patients with prostate cancer was vulnerable to SPM, accounting for 34.59%, and SPM was prone to occur in lung and bronchus, accounting for 24.90%. The heat map shows that esophagus cancer survivors have the highest risk of developing stomachache tumors (SIR =5.08). The result of Cox regression suggests that a history of liver was associated with the shortest survival time (HR =1.64, 95% CI, 1.54-1.75, P<0.001).

Conclusions: With the advancement of medical standards, the survival time of cancer patients is prolonged, but the occurrence of SPM is also increasing, and the prognosis is not optimistic. More attention needs to be invested in the prevention and treatment of SPM.

Keywords: SEER; Second primary malignancy (SPM); epidemiological investigation; median survival time; standard incidence rate (SIR).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-2059). XL serves as an unpaid section editor of Annals of Translational Medicine from Jan 2020 to Dec 2021. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of the results of search strategy.
Figure 2
Figure 2
The specific location composition and difference of FPM and SPM. (A) Comparison of the number of all SPM patients and the number of people included stratified by the location of the FPM. (B) Distribution of patients in the analysis cohort according to the primary sites of FPM. (C) Distribution of patients in the analysis cohort according to the primary sites of SPM/events. (D) FPM and SPM/events are ranked by number of cases. FPM, first primary malignancy; SPM, second primary malignancy.
Figure 3
Figure 3
Month Since Index, median survival time and follow-up time of the analytic cohort.
Figure 4
Figure 4
Number of cases and the risk of SPM in the forms of standard incidence rate of multiple primary (MP-SIR). (A). Heat map of the number of cases. (B) Heat map of the SIR of cases. (C) Heat map of the normalized SIR of cases. SIR, standardized incidence ratio
Figure 5
Figure 5
Comparison of COD of different cancer stratified by primary site. COD, cause of death.
Figure S1
Figure S1
The results of optimal cut-off point of the Month Since Index by using the X-tile program. (A,B) The optimal cut-off value of Month Since Index was identified by X-tail. (C) The Kaplan-Meier curves for overall survival.
Figure S2
Figure S2
Detailed information about the distribution of SPM locations in 16 common malignancies. SPM, second primary malignancy.
Figure S3
Figure S3
The risk of cases with the same site of FPM and SPM in the forms of standard incidence rate of multiple primary (MP-SIR). (A) Heat map of the SIR of cases with same site of FPM and SPM. (B) Heat map of the normalized SIR of cases with same site of FPM and SPM. FPM, first primary malignancy; SPM, second primary malignancy.
Figure S4
Figure S4
The survival analysis of FPM and SPM. (A) Kaplan-Meier (K-M) survival curves of FPM. (B) Kaplan-Meier (K-M) survival curves of SPM. FPM, first primary malignancy; SPM, second primary malignancy.
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