Increased incidence of second primary malignancy in patients with malignant astrocytoma: a population-based study

AbstractWe identified patients diagnosed with malignant astrocytoma (MA) as the first of two or more primary malignancies between 1973 and 2015 from Surveillance, Epidemiology and End Results (SEER) database. Multiple primaries-standardized incidence ratio (MP-SIR) was calculated to quantitate the risk of second primary malignancy (SPM). We further identified the risk factors of developing SPM and factors affecting overall survival (OS) in MA patients with SPM. Our results revealed that overall risk of SPM among MA patients was significantly higher than that in general population (SIR: 1.09, 95% confidence interval (CI): 1–1.18, P<0.05). Specific sites where the risk of SPM increased included salivary gland, bone and joints, soft tissue including heart, brain, cranial nerves other nervous system, thyroid, acute non-lymphocytic leukemia and acute myeloid leukemia. Overall risk of SPM in patients aged ≤29 and 30–59 years significantly increased (4.34- and 1.41-fold respectively). Whereas patients aged ≥60 years had a significantly decreased risk of SPM. Patients in the group of latency at 36–59, 60–119 and ≥120 months carried significantly increased overall risk of SPM. Multivariate analysis revealed that age, race, marital status, WHO grade, differentiated grade of cancer tissues, latency was independent predictor of OS in MA patients with SPM, which were all selected into the nomogram. The calibration curve for probability of survival showed good agreement between prediction by nomogram and actual observation. In conclusion, MA survivors should be advised of their increased risk for developing certain cancers in their lifetime. Our study had clinical implications for the surveillance of MA survivors at risk of developing SPM.

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The risk of second primary malignancy in patients with localized thymoma: A U.S. population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.8568 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 8568-8568

Author(s):

Dipesh Uprety ◽

Lubina Arjyal ◽

Swapna Narayana ◽

Peter James Polewski ◽

Amir Bista ◽

...

Keyword(s):

Statistical Significance ◽

Population Based ◽

Anterior Mediastinum ◽

Lymphocytic Leukemia ◽

Second Primary ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Limited Stage ◽

Hepatobiliary Cancer ◽

Increased Risk

8568 Background: Thymoma is a rare neoplasm of anterior mediastinum. Patients often have an indolent disease. The prognosis of limited stage disease is excellent with a 10-year survival rate of 70 to 80%. Data regarding the risk of second primary malignancy in thymoma survivors are limited in recent years. In this study, we aimed to determine the risk of second primary malignancies (SPMs) among patients with limited stage thymoma. Methods: We utilized the Surveillance, Epidemiology and End Results (SEER)-13 registry to identify adult patients (≥ 18 years) with limited stage thymoma. We calculated the risk of SPM, developing ≥ 6 months after an index thymoma diagnosis, using Multiple Primary Standardized Incidence Ratio and an Absolute Excess Risk (AER) between 2004 and 2010. Statistical significance was defined as p < 0.05. Results: The database identified a cohort of 1,544 patients with limited stage thymoma with a median follow-up duration of 107 months (11-281 months). A total of 176 (11.39%) patients developed SPMs with a median latency of 62.5 months (range 6-272 months). Median age at diagnosis of SPM was 69 years (range 25- 96 years). Overall, SPM occurred at an observed to expected (O/E) ratio of 1.53 (95% CI 1.32-1.76), p < 0.001 with an AER of 60.52 per 10,000 patient-years at risk. A significantly increased risk was noted for cancer of lung and bronchus (O/E 1.77, 95% CI 1.21-2.52, p = 0.004; AER 12.17/10,000), skin excluding basal and squamous (O/E 2.09, 95% CI 1.04-3.75, p = 0.03; AER 5.17/10,000), urinary bladder (O/E 2.14, 95% CI 1.17-3.6, p = 0.014; AER 6.72/10,000), thyroid (O/E 3.48, 95% CI 1.4-7.17,p = 0.009; AER 4.49/10,000), and leukemia (O/E 3.26, 95% CI 1.63-5.83, p = 0.001; AER 6.86/10,000), including acute lymphocytic leukemia (O/E 16.09, CI: 1.95-58.11; AER 1.69/10,000), acute myeloid leukemia (O/E 3.83, CI: 1.04-9.8; AER 2.66/10,000) and other acute leukemia (O/E 29.45, CI: 3.57-106.39; AER 1.74/10,000). The risk was not significant for lymphoma (Hodgkin and non-Hodgkin), chronic leukemia, oropharyngeal, digestive tract and hepatobiliary cancer as SPM. Conclusions: The risk for SPMs is significantly increased in patient with thymoma compared to general population. Given the long-term risk of SPM, patient should be followed closely with judicious use of age-appropriate cancer screening.

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Incidence of Second Malignancy in Patients with Papillary Thyroid Cancer from Surveillance, Epidemiology, and End Results 13 Dataset

Journal of Thyroid Research ◽

10.1155/2018/8765369 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Mayumi Endo ◽

Jessica B. Liu ◽

Marcelle Dougan ◽

Jennifer S. Lee

Keyword(s):

Thyroid Cancer ◽

Papillary Thyroid Cancer ◽

Incidence Rates ◽

Lymphocytic Leukemia ◽

Second Primary ◽

Papillary Thyroid ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Increased Risk ◽

End Results

Increased risk of second primary malignancy (SPM) in papillary thyroid cancer (PTC) has been reported. Here, we present the most updated incidence rates of second primary malignancy from original diagnosis of PTC by using the data from the Surveillance, Epidemiology, and End Results. In this cohort, 3,200 patients developed SPM, a substantially higher number than in the reference population of 2,749 with observed to expected ratio (O/E) of 1.16 (95% CI; 1.12–1.21). Bone and joint cancer had the highest O/E ratio of 4.26 (95% confidence interval [CI] 2.33–7.15) followed by salivary gland (O/E 4.15; 95% CI 2.76–6.0) and acute lymphocytic leukemia (O/E 3.98; 95% CI 2.12–6.8). Mean age at the diagnosis of SPM was 64.4 years old. Interestingly, incidence of colorectal cancer was lower in thyroid cancer survivors compared to general population (large intestine O/E 0.3; 95% CI 0.06–0.88, rectum O/E 0.6; 95% CI 0.41–0.85); however, this was not observed in patients who underwent radiation therapy. The incidence of SPM at all sites was higher during 2000–2012 compared to 1992–1999 (O/E 1.24 versus 1.10). Surprisingly, patients with micropapillary cancer had higher incidence of SPM than counterparts with a larger tumor in radiation group (O/E of 1.40 versus 1.15). O/E of all cancers were higher in males compared to females with O/E of 1.41 versus 1.17 during the period of 2000–2012. Diagnosis of PTC before age 50, especially at age 30–34, was associated with higher incidence of overall SPM (age 30–34; O/E 1.43; 95% CI; 1.19–1.71). Efficient monitoring strategies that include age at the time of thyroid cancer diagnosis, exposure to radiation, gender, and genetic susceptibility may successfully detect SPM earlier in the disease course. This is especially important given the excellent prognosis of the initial thyroid cancer itself.

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The impact of primary tumor location (PTL) and age on the risk of developing noncolonic second primary malignancy (SPM) in colon cancer (CC) patients (PTS).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.67 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 67-67

Author(s):

Charles Chu ◽

Albert Y. Lin

Keyword(s):

Colon Cancer ◽

Early Onset ◽

Tumor Location ◽

Population Based ◽

Second Primary ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Incidence Data ◽

Increased Risk ◽

The Impact

67 Background: Colon cancer remains one of the leading causes of cancer death worldwide. There has been a renewing interest in the role of PTL (right- or RS vs. left-sided or LS) in CC for their differences in biology, prognostic and predictive features. Given the increasing incidence of early-onset (age 20-49) CC, coupled with their longer life expectancy, we seek to examine the effects of PTL and age in the development of SPM in a population-based cohort. Methods: Surveillance, Epidemiology, and End Results (SEER) Program data were queried to identify CC PTS diagnosed between 1973-2015 with complete follow-up information and available data on SPM. Using SEER*Stat, we calculated standardized incidence ratios (SIRs) -- the ratio of observed to expected cases of SPM based on incidence data in the general US population and compared by PTL (RS vs. LS) and age of diagnosis (20-49 vs. >49). Results: A total of 269,442 (RS/LS=46.4%/53.6%) CC PTS were obtained. Overall RS, compared with LS, CC PTS have a higher likelihood of developing SPM in all sites (OR: 1.09, 95% CI: 1.08- 1.11 vs. 1.03, 1.02-1.04). RS CC PTS and age 20-49 group, compared with other subgroups, has a much greater likelihood of being diagnosed with the following SPM:small intestine, urinary tract, bile duct, gynecologic (GYN), and stomach cancers, as shown in the Table below. Conclusions: Our results show that the increased risk in non-colonic SPMs in CC PTS is associated with RS CC and age less than 49, suggesting the implications on survivorship care and surveillance of SPMs. Furthermore, there may be a possible overlap with Lynch syndrome in these PTS with SPM given the overlap in the presentation of cancer patterns and early-onset of CC, suggesting the indication for MMR testing. [Table: see text]

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Second Primary Malignancy Risk Among HIV-Uninfected and HIV-Infected Survivors of Hodgkin Lymphoma: A 30-Year Follow-up Population-Based Study

Blood ◽

10.1182/blood-2020-137728 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 15-17

Author(s):

Renata Abrahao ◽

Ann M Brunson ◽

Justine M. Kahn ◽

Qian Li ◽

Aaron S Rosenberg ◽

...

Keyword(s):

General Population ◽

Hodgkin Lymphoma ◽

Population Based ◽

Second Primary ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Female Breast ◽

Over Time ◽

Overall Risk

Introduction Second primary malignancy (SPM) is one of the most devastating late complications following Hodgkin lymphoma (HL) treatment. Historically, the most common SPMs in patients treated for HL are solid tumors, which are largely related to radiation exposure during initial therapy. For the last three decades, efforts to address the risk of SPM after HL therapy have focused on reducing exposure to radiation, as well as refining the approach for patients where radiation is indicated. To date, few population-based studies in the United States have quantified the burden of SPMs and evaluated the potential effect of changes in therapeutic management over time. Additionally, to our knowledge, no study has compared SPM risk between human immunodeficiency virus (HIV)-infected and HIV-uninfected HL survivors. Methods We used data from the California Cancer Registry on 21,043 patients diagnosed with primary HL between 1988 and 2015 with follow-up through 2017. We calculated standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (CIs) and absolute excess risks (AERs) to compare SPM incidence in our HL cohort with the expected number of first primary cancer incidence in the general California population, based on patient's age at diagnosis (5-year categories), sex, calendar year (3-year intervals), cancer site, and race/ethnicity. SIRs are presented by HIV status, SPM latency, treatment era, and cancer type. P-values for trends were used to examine whether SPM risk changed over time. Findings Among 20,303 HIV-uninfected patients (median follow-up of 14.1 years), overall SPM risk was increased 1.95-fold compared with the general population (SIR=1.95, 95% CI 1.86-2.04). In 740 HIV-infected patients (median follow-up of 11.7 years), overall risk was increased 2.68-fold compared with the general population (SIR=2.68, 95% CI 2.0-3.40), translating to an 37% higher incidence of SPM in HIV-infected vs. HIV-uninfected patients. The AER (per 10,000 person-years) of SPM was 43.1 in HIV-uninfected and 76.5 in HIV-infected patients, resulting in a 33.4 excess SPM per 10,000 person-years in HL survivors with HIV. Malignancies that contributed the most to overall AER were non-Hodgkin lymphoma (NHL), female breast and lung cancers in HIV-uninfected patients; and Kaposi sarcoma, NHL, anorectal and head & neck (HNC) cancers in HIV-infected patients. Notably, among HIV-uninfected patients, the highest overall risk of SPM occurred ≥20 years after diagnosis (SIR= 2.27, 95% CI 1.99-2.58) (Figure). In contrast, the highest overall risk in HIV-infected patients was observed <2 years after diagnosis (SIR=4.42, 95% CI 2.53-7.19). Radiation used decreased from 46.9% in 1988-1996 to 29.5% in 2007-2015. Among HIV-uninfected patients, there was a trend towards decreased risk over time of overall and selected solid SPMs (lung, female breast, and gastrointestinal cancers) (Table). In an analysis restricted to HIV-uninfected patients who received radiation irrespective of chemotherapy, findings also suggested a declined risk of overall and selected solid SPMs over time: any solid (SIR=2.15 in 1988-1996 and SIR=1.30 in 2007-2015, p<0.0001), lung (SIR=3.69 in 1988-1996 and SIR=1.81 in 2007-2015, p=0.0031), and female breast (SIR=2.95 in 1988-1996 and SIR=0.63 in 2007-2015, p<0.0001). Conclusion Compared with the general population, the risk of developing a SPM following HL treatment was significantly higher among both HIV-uninfected and HIV-infected patients, with the absolute excess risk greater for those with HIV infection. There were different temporal patterns and types of SPM between HIV-uninfected and HIV-infected patients. These findings prompt the question on whether earlier and/or more intensive cancer screening should be pursued for HIV-infected survivors. The trend towards decreased risk for selected solid SPMs among HIV-uninfected patients, especially lung and female breast cancers, suggest that strategies to reduce radiation in HL survivors may be working. Despite promising trends in this group, the observation that SPM risk was highest ≥20 years after initial therapy further highlights the need for long-term surveillance and survivorship care in this at-risk population. Disclosures Rosenberg: Takeda: Speakers Bureau; Janssen: Speakers Bureau; Amgen: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees. Wun:Glycomimetics, Inc.: Consultancy.

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1066Increased Risk of Suicide among Cancer Survivors Who Developed a Second Primary Malignancy

International Journal of Epidemiology ◽

10.1093/ije/dyab168.732 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Huazhen Yang ◽

Chengshi Wang ◽

Donghao Lu ◽

Huan Song

Keyword(s):

Prostate Cancer ◽

Cancer Survivors ◽

Population Based ◽

Second Primary ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Completed Suicide ◽

Hazard Ratios ◽

Increased Risk ◽

Cox Proportional Hazard Models

Abstract Background Cancer diagnosis entails substantial psychological distress and is associated with dramatically increased risks of suicide and psychiatric disorders. However, little is known about the suicide risk among cancer survivors who developed a second primary malignancy (PCa-2). Methods Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study, including 7,169,704 patients with first primary malignancy (PCa-1) and 686,174 PCa-2 patients diagnosed from January 1, 1975, through December 31, 2016. Compared with patients with PCa-1, we measured the hazard ratios (HRs) of completed suicide after receiving a PCa-2 diagnosis, using Cox proportional hazard models. Results 10,938 and 937 completed suicides were identified among PCa-1 and PCa-2 patients, respectively. The HR of suicide deaths was 1.24 [95% confidence interval (CI), 1.15-1.32] after a PCa-2 diagnosis, compared with PCa-1 patients (adjusted for demographic factors, state, and tumor characteristic). The risk elevation was most pronounced when PCa-2 was prostate cancer (HR 1.37, 95% CI 1.18-1.60); and PCa-2 patients diagnosed between 60 to 75 years old had highest increased relative risk of suicide (HR 1.35, 95% CI 1.23-1.49). Conclusions Compared with patients with first primary cancer, cancer survivors receiving a PCa-2 diagnosis, particularly of prostate cancer or at age 60-75, are at increased risk of suicide. These findings emphasize the need to support and carefully monitor cancer survivors for PCa-2. Key messages Patients with PCa-2 are at a higher risk of suicide compared with patients with PCa-1, especially for PCa-2 diagnosed at age 60 to 75 or PCa-2 of prostate.

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The risk and prognosis of secondary primary malignancy in lung cancer: a population-based study

Future Oncology ◽

10.2217/fon-2021-0045 ◽

2021 ◽

Author(s):

Jia Hong ◽

Rongrong Wei ◽

Chuang Nie ◽

Anastasiia Leonteva ◽

Xu Han ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Cox Regression ◽

Population Based ◽

Second Primary ◽

Second Primary Malignancy ◽

Risk Models ◽

Primary Malignancy ◽

Population Based Study ◽

Competing Risk Models

Aim: To assess and predict risk and prognosis of lung cancer (LC) patients with second primary malignancy (SPM). Methods: LC patients diagnosed from 1992 to 2016 were obtained through the Surveillance, Epidemiology, and End Results database. Standardized incidence ratios were calculated to evaluate SPM risk. Cox regression and competing risk models were applied to assess the factors associated with overall survival, SPM development and LC-specific survival. Nomograms were built to predict SPM probability and overall survival. Results & conclusion: LC patients remain at higher risk of SPM even though the incidence declines. Patients with SPM have a better prognosis than patients without SPM. The consistency indexes for nomograms of SPM probability and overall survival are 0.605 (95% CI: 0.598–0.611) and 0.644 (95% CI: 0.638–0.650), respectively.

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Second primary malignancy in patients with cholangiocarcinoma: a population-based study

Cancer Management and Research ◽

10.2147/cmar.s187614 ◽

2019 ◽

Vol Volume 11 ◽

pp. 1969-1983 ◽

Cited By ~ 1

Author(s):

Liping Zhuang ◽

Xia Yan ◽

Zhiqiang Meng

Keyword(s):

Population Based ◽

Second Primary ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Population Based Study

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Risk of second malignancy in patients with ovarian clear cell carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001946 ◽

2020 ◽

pp. ijgc-2020-001946

Author(s):

Julie My Van Nguyen ◽

Danielle Vicus ◽

Sharon Nofech-Mozes ◽

Lilian T Gien ◽

Marcus Q Bernardini ◽

...

Keyword(s):

Radiation Therapy ◽

Cell Carcinoma ◽

Clear Cell ◽

Clear Cell Carcinoma ◽

Second Primary ◽

Ovarian Clear Cell Carcinoma ◽

Second Primary Malignancy ◽

Primary Malignancy ◽

Increased Risk ◽

Second Primary Malignancies

ObjectiveOvarian clear cell carcinoma has unique clinical and molecular features compared with other epithelial ovarian cancer histologies. Our objective was to describe the incidence of second primary malignancy in patients with ovarian clear cell carcinoma.MethodsRetrospective cohort study of patients with ovarian clear cell carcinoma at two tertiary academic centers in Toronto, Canada between May 1995 and June 2017. Demographic, histopathologic, treatment, and survival details were obtained from chart review and a provincial cancer registry. We excluded patients with histologies other than pure ovarian clear cell carcinoma (such as mixed clear cell histology), and those who did not have their post-operative follow-up at these institutions.ResultsOf 209 patients with ovarian clear cell carcinoma, 54 patients developed a second primary malignancy (25.8%), of whom six developed two second primary malignancies. Second primary malignancies included: breast (13), skin (9), gastrointestinal tract (9), other gynecologic malignancies (8), thyroid (6), lymphoma (3), head and neck (4), urologic (4), and lung (4). Eighteen second primary malignancies occurred before the index ovarian clear cell carcinoma, 35 after ovarian clear cell carcinoma, and 7 were diagnosed concurrently. Two patients with second primary malignancies were diagnosed with Lynch syndrome. Smoking and radiation therapy were associated with an increased risk of second primary malignancy on multivariable analysis (OR 3.69, 95% CI 1.54 to 9.07, p=0.004; OR 4.39, 95% CI 1.88 to 10.6, p=0.0008, respectively). However, for patients developing second primary malignancies after ovarian clear cell carcinoma, radiation therapy was not found to be a significant risk factor (p=0.17). There was no significant difference in progression-free survival (p=0.85) or overall survival (p=0.38) between those with second primary malignancy and those without.ConclusionPatients with ovarian clear cell carcinoma are at increased risk of second primary malignancies, most frequently non-Lynch related. A subset of patients with ovarian clear cell carcinoma may harbor mutations rendering them susceptible to second primary malignancies. Our results may have implications for counseling and consideration for second primary malignancy screening.

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