Risk of second primary malignancies after definitive treatment for esophageal cancer: A competing risk analysis

Abstract

BackgroundEsophageal cancer is associated with synchronous or metachronous cancer at other primary sites. However, few studies have evaluated the second malignancies after the treatment of esophageal cancer. The present study aimed to clarify the frequency of and risk factors for the second malignancies after definitive therapy for esophageal cancer.Patients and MethodsWe included patients with esophageal cancer who received definitive therapy between 2000 and 2010. Exclusion criteria were synchronous cancer or a past history of cancer. Standardized incidence rate (SIR) was calculated using age‐ and sex‐specific incidence rates from the cancer registry data. To conduct risk analyses, we used the competing risk regression model, which defined death and the development of second malignancies as competing risks.ResultsA total of 758 patients were included, with 131 second malignancies occurring in 106 patients (14%), over a median follow‐up of 3.7 years. Cumulative incidences of second malignancies after 3, 5, and 8 years were 4.0%, 7.6%, and 13.8%, respectively. The risk of second malignancy was significantly elevated [SIR = 1.83, 95% confidence interval (CI): 1.50‐2.22]. The most common sites of primary tumor were the head and neck (20%), followed by the lung (17%), stomach (16%), colon and rectum (11%), and urinary tract (9%). Risk analyses revealed that age ≥ 65 years [subdistribution hazard ratio (sHR): 1.51, 95% CI: 1.01‐2.24, vs age < 65] and clinical stages 0‐I (sHR: 2.48, 95% CI: 1.46‐4.22, vs stage III and IV) and II (sHR: 2.10, 95% CI: 1.23‐3.58, vs stage III and IV) were significantly associated with second malignancies.ConclusionsCompared with the general population, an increased incidence of second malignancies was observed in the patients with esophageal cancer in the present study even after definitive treatment. Careful follow‐up is required, especially in patients at a higher risk of second malignancies.

Increased risk of second primary tumours in patients with oesophageal squamous cell carcinoma: a nationwide study in a Western population

“…15 Other studies also reported increased MPT risks. 10,14,24,30,32 As reported in our study, patients with ESCC diagnosis at a young age showed the highest SIR for developing both synchronous (SIR 32.07) and metachronous MPTs (SIR 70.87). The same results were reported in a study by Chen et al, with a SIR of 36.56 for patients aged between 20-39 years at ESCC diagnosis.…”

Secondary Primary Lung Cancer After Esophageal Cancer: A Population-Based Study of 44,172 Patients

“…In this study, we found a statistically signi cant increase in SPLC risk in all EC survivors in comparison with the incidence rates of general population, with similar results having been reported in some studies [5][6][7][8]10], which focused more on the overall second primary cancer risk rather than SPLC risk. In this large population-based study, the data of EC-LC patients were reviewed in more detail and SIRs were assessed for different patient groups with regard to race, latency, age, year of diagnosis and sex.…”

“…Esophageal cancer (EC) is the sixth most common cause of cancer-related death, leading to approximately four hundred thousand deaths per year [1]. Although esophageal cancer incidence rates in U.S. have tended to decrease [2][3], the incidence rates of secondary primary malignancy (SPM) after EC have tended to increase because of increasing numbers of long-term cancer survivors [4].…”

“…Lung cancer (LC) is one of the most frequently occurring SPM after an EC. There have been several studies describing an increased incidence of secondary primary lung cancer (SPLC) in the EC population, which may be explained by the concept of " eld cancerization" [5][6][7][8][9][10]. Notwithstanding several reports have discussed the risk of SPMs, including SPLC, most of these exclusively focused on the frequency of and risk factors of SPMs, rather than focusing on the subsequent survival.…”

Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer

“…The current study demonstrated that most failures were developed within the first three years after CRT. After that point, surveillance for second primary tumors may be of importance, considering the high occurrence of a second SCC due to the close association of alcohol consumption and smoking habits [45]. Whether early detection and treatment of second primaries improves patient outcomes is currently unknown.…”