Distinct Features of Second Primary Malignancies in Head and Neck Cancer Patients in Japan

Abstract

Second primary malignancies (SPMs) are one of the most critical problems in treating head and neck cancer patients. Our hospital had 742 patients with a diagnosis of malignant head and neck tumors during the five-year period from 2002 to 2006. In this study, we analyzed 360 of those patients who were assumed to have risk factors such as alcohol and tobacco use: 106 oral, 120 laryngeal, 50 oropharyngeal and 84 hypopharyngeal cancer patients. Synchronous SPMs are defined as second cancers diagnosed at the same time or within 6 months of the diagnosis of the index head and neck cancers. There were 4 (3.8%) and 11 (10.4%) oral cancer patients, 11 (8.3%) and 8 (5.8%) laryngeal cancer patients, 7 (14.0%) and 4 (8.0%) oropharyngeal cancer patients, and 30 (28.6%) and 7 (8.3%) hypopharyngeal cancer patients with synchronous and metachronous SPMs, respectively. The number of metachronous patients with synchronous SPMs tended to increase during this time period. The frequencies of SPMs in oropharyngeal and hypopharyngeal cancer patients are similar to those in oral and laryngeal cancer patients. Notably, the most frequent SPMs are upper gastrointestinal tract cancers in Japan, compared to lung cancers in Europe. The five-year overall survival rate of patients with synchronous SPMs was significantly poorer than that of patients without any other tumor except for the index cancer, according to the Kaplan-Meier analysis. In conclusion, searching for SPMs in the upper gastrointestinal tract is a critical issue in head and neck cancer patients in Japan.Keywords: diagnosis; head and neck cancer; prognosis; second primary malignancy; synchronous and metachronous Tohoku J. Exp. Med., 2011, 225 (1), 5-12. © 2011 Tohoku University Medical Press Squamous cell carcinoma of the head and neck is the sixth most common cancer worldwide and approximately 600,000 patients develop this type of cancer each year around the world. Despite marked improvements in locoregional control of head and neck squamous cell carcinomas over the past several decades, the overall survival rate of the patients has not changed (Pisani et al. 1999;Parkin et al. 2005). One major reason for the lack of improved overall survival of patients with head and neck cancers is the increased risk of developing a second primary malignancy (SPM). Most SPMs originate independently from the index cancers because these tumors are not clonally related as proven by genetic examination (Califano et al. 1999;Shiga et al. 2003). It is thought that this different clonal origin of SPMs results in treatment difficulties. There are two types of SPMs, metachronous and synchronous, and some patients have both types of SPMs. SPMs are critical problems that must be considered to treat patients with head and neck carcinomas. Such treatment happens to be very difficult in some cases because of the advanced stage of the disease and/or difficulties in the management of treatment strategies and timing especially when they have synchronous SPMs. It is well known that smoking and alcohol use are ...

Survival analysis of patients with oral squamous cell carcinoma with simultaneous second primary tumors

“…The incidences of synchronous and metachronous SPT in this study were 6.2% (including simultaneous SPT) and 14.8%, respectively. Those were comparable with previous studies, which reported incidences of synchronous SPT that ranged from 3.8% to 7.0% and incidences of metachronous SPT that ranged from 9.0% to 20% . In the current study, all simultaneous SPTs were located inside the oral cavity.…”

“…Previous studies reported the rates of second primaries of head and neck squamous cell carcinomas varying from 8% to 21% . A study analyzing patients with laryngeal carcinoma showed a significant reduction of survival rate in patients developing a second primary tumor (SPT) when compared to those without .…”

“…A study analyzing patients with laryngeal carcinoma showed a significant reduction of survival rate in patients developing a second primary tumor (SPT) when compared to those without . The 5‐year overall survival rate of patients with head and neck cancer with SPT was significantly poorer than that of patients without . When a second primary cancer developed, the mean survival time was reduced.…”

Epidemiology of Oral Cancer in Asia in the Past Decade- An Update (2000-2012)

“…Most recurrences are local (Hakeem et al, 2012;Priya et al, 2012). A considerable proportion of cases (34%) in Japan presented with second primaries (Shiga et al, 2011). The clinicopathological factors that influence the treatment outcome and likelihood of recurrence are use of tobacco, advanced T stage or stage III-IV disease at diagnosis, including local regional nodal involvement, positive resection margins or the resection margins being very close to the tumour and thickness of tumour ≥7mm (Battoo et al, 2012;Hakeem et al, 2012;Priya et al, 2012;Wang et al, 2012).…”

Spindle cell carcinoma of the tongue combined with double primary cancer of the thyroid gland: a case report

“…Those studies have reported that the prognosis of patients with synchronous cancers is significantly lower than that of patients with metachronous cancers, and that second primary malignancies in the esophagus or lung contribute to a poorer outcome relative to other types. This suggests that the decline in survival rates in patients with SPTs is due to high morbidity requiring multiple surgeries, lack of well-established treatment in managing multifocal oral cancers, restricted therapeutic options, and relevant habits of the patient1920.…”