Analysis of prognosis and treatment decisions for patients with second primary lung cancer following esophageal cancer

Abstract

IntroductionAs the long-term prognosis of esophageal cancer (EC) is improving, concerns of a second primary malignancy (SPM) have increased. However, research on lung cancer as the SPM after EC is limited. Therefore, we aimed to explore the prognostic factors and clinical treatment decisions of patients with second primary lung cancer following esophageal cancer (SPLC-EC).Materials and methodsWe identified the data of 715 patients with SPLC-EC from the Surveillance, Epidemiology, and End Results (SEER) database during 1975 to 2016. We established a nomogram through Cox regression modelling to predict the prognosis of patients with SPLC-EC. We determined the association between factors and cancer-specific mortality using the Fine-Gray competing risk model. Then, we performed survival analysis to evaluate the benefits of different treatment methods for overall survival (OS).ResultsThe multivariate analysis indicated that sex, insurance recode, age, surgery and chemotherapy 0for first primary malignancy (FPM), primary site, stage, and surgery for SPM were independent prognostic factors for OS. Using concordance indices for OS, the nomogram of our cohort showed a higher value than the SEER historic-stage nomogram (0.8805 versus 0.7370). The Fine-Gray competing risk model indicated that surgery for FPM and SPM was the independent prognostic factor for EC-specific mortality (P=0.016, hazard ratio [HR] = 0.532) and LC-specific mortality (p=0.016, HR=0.457), respectively (p<0.001). Compared to the patient group having distant metastasis, patients with localized and regional metastasis benefitted from undergoing surgery for SPM (P<0.001, P<0.001, respectively). For patients without surgery for SPM, radiotherapy (P<0.001) and chemotherapy (P<0.001) could improve OS.ConclusionsSurgery remains the mainstay for managing SPLC-EC, especially for localized and regional tumors. However, chemotherapy and radiotherapy are recommended for patients who cannot undergo surgery. These findings can have implications in the treatment decision-making for patients with SPLC-EC.

Analysis of related factors of CRA in lung cancer patients with different serum iron levels: A retrospective cohort study

“…Based on these factors, nomogram prediction models for CRA are constructed for both patient groups, demonstrating good prediction efficiency and clinical practicality. Previous studies have shown that serum iron levels are negatively correlated with tumor staging and positively correlated with patient prognosis in lung cancer cases, 25 as the incidence of CRA in lung cancer patients tends to increase with later stages of cancer and lower levels of serum iron due to tumor cell proliferation and increased demand for iron. Malignant tumors are consumptive diseases, and with the progression of the disease, some patients with advanced lung cancer consume more in the body because of the deterioration of malignant fluid, which leads to the decrease in serum iron content of hematopoietic raw materials, thus leading to CRA.…”

Review of the relationship between tumor receptor subtypes and preference for visceral and/or serosal metastasis in breast cancer patients

“…[31,32] A retrospective study of a large cohort of patients with a history of invasive breast cancer revealed that 5.34% of the patients developed malignant pleural and/or pericardial fluid as the first clinical sign of distant metastasis. [33] The pericardium is not the preferred site of metastasis in breast cancer, and pericardial metastasis develops in only 19% of cases. Approximately 12 to 25% of breast cancer cases with pericardial metastasis have pericardial effusion.…”

“…Since most cases do not present clinically, they are not diagnosed until autopsy. [34][35][36] Involvement of the peritoneal surfaces, which is another serosal involvement of breast cancer, is a rare clinical manifestation that usually occurs during progressive progression or is much less frequently detected at the initial diagnosis. The most common diagnostic finding is diffuse peritoneal thickening and ascites development.…”

Risk Prediction of Second Primary Malignancies in Patients after Rectal Cancer: Analysis Based on SEER Program

“…As the incidence of SPMs increases signi cantly, recent developments in SPMs have heightened the need for research on the monitoring, prognosis, and treatment decisions for clinical and public health [20,21].…”