scholarly journals A Competing-Risk Nomogram Predicting Second Primary Malignancy in Hepatocellular Carcinoma Survivors

2020 ◽  
Author(s):  
Xuqi Sun ◽  
Jinbin Chen ◽  
Juncheng Wang ◽  
Zhongguo Zhou ◽  
Li Xu ◽  
...  
Keyword(s):  
Risk Model ◽  
Extrahepatic Bile Duct ◽  
Competing Risk ◽  
Second Primary ◽  
Second Primary Malignancy ◽  
Primary Malignancy ◽  
Predicting Model ◽  
System P ◽  
Surgical History ◽  
Second Primary Malignancies

Abstract Background:Hepatocellular carcinoma (HCC) survivors are increasing due to the improvement of survival. Follow-up scheme to prevent recurrence is routinely recommended, but are these patients exposed to increased risks of second malignancies remains unknown. We aimed to identify risk factors for second primary malignancies (SPM) among HCC survivors and develop a predicting model accordingly. Methods: We identified HCC patients in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2014. For the incidence of specific SPMs, standardized incidence ratios (SIRs) were calculated. The proportional hazard model was performed in order to discover hazards of SPM, and a competing-risk nomogram was developed to stratify patients with different incidences for SPM. Results:The crude incidence of SPM was 2.70% in HCC survivors, with the SIR of 1.09. HCC survivors had significantly higher incidences of SPM in the following sites: oral cavity and pharynx, stomach, intra and extrahepatic bile duct, lung and bronchus, kidney and renal pelvis, thyroid and lymphatic system (p< 0.05). Patients with diagnosed age at 61-75 years old, smaller tumor size, better histologic differentiation, earlier AJCC stage or surgical history had higher risks for SPM. The c-index of the competing-risk nomogram was 0.663. The cumulative incidences of SPM were significantly different among each quartile of patients stratified by the predicting model (p< 0.05). Conclusion:HCC survivors had an excess risk for SPMs, especially those with promising prognostic factors. This nomogram was the first competing-risk model for identifying high-risk cohort and assist clinical screening.

Risk of second malignancy in patients with ovarian clear cell carcinoma

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.

A review of second primary malignancy in patients with relapsed or refractory multiple myeloma treated with lenalidomide

Blood ◽  
2012 ◽  
Vol 119 (12) ◽  
pp. 2764-2767 ◽  
Author(s):  
Meletios A. Dimopoulos ◽  
Paul G. Richardson ◽  
Nancy Brandenburg ◽  
Zhinuan Yu ◽  
Donna M. Weber ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Pooled Analysis ◽  
Second Primary ◽  
Separate Analysis ◽  
Second Primary Malignancy ◽  
Primary Malignancy ◽  
Pivotal Phase ◽  
Refractory Multiple Myeloma ◽  
Skin Cancers ◽  
Second Primary Malignancies

Abstract In a retrospective pooled analysis of 11 clinical trials of lenalidomide-based therapy for relapsed/refractory multiple myeloma (MM; N = 3846), the overall incidence rate (IR, events per 100 patient-years) of second primary malignancies (SPMs) was 3.62. IR of invasive (hematologic and solid tumor) SPMs was 2.08, consistent with the background incidence of developing cancer. In a separate analysis of pooled data from pivotal phase 3 trials of relapsed or refractory MM (N = 703), the overall IR of SPMs was 3.98 (95% confidence interval [CI], 2.51-6.31) with lenalidomide/dexamethasone and 1.38 (95% CI, 0.44-4.27) with placebo/dexamethasone; IRs of nonmelanoma skin cancers were 2.40 (95% CI, 1.33-4.33) and 0.91 (95% CI, 0.23-3.66), respectively; IRs of invasive SPMs were 1.71 (95% CI, 0.86-3.43) and 0.91 (95% CI, 0.23-3.66), respectively. The risk of SPMs must be taken into account before initiating lenalidomide treatment. In the context of the observed survival benefit in relapsed or refractory MM patients, the benefit/risk profile of lenalidomide/dexamethasone remains positive.

scholarly journals Risk of Second Primary Malignancy in Multiple Myeloma in the Novel Therapy Era from 15 Years of Cancer Registry

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1878-1878
Author(s):  
Hsin-An Hou ◽  
Yanfang Liu ◽  
Hong Qiu ◽  
Hwei-Fang Tien ◽  
Chao-Hsiun Tang
Keyword(s):  
Cancer Registry ◽  
Research Funding ◽  
Risk Model ◽  
Novel Agents ◽  
Cumulative Probability ◽  
Second Primary ◽  
First Line ◽  
Second Primary Malignancy ◽  
Primary Malignancy ◽  
Equity Ownership

Background: Novel agents such as thalidomide and bortezomib have changed the treatment landscape of multiple myeloma (MM). As patients with MM live longer, the risk of developing a second primary malignancy (SPM) increases. Few data describe the rate of SPM in patients with MM in Asia. Objectives: To describe SPM in patients with MM using the Taiwan Cancer Registry according to first-line treatment regimen. Methods: Connections between MM treatment and SPM were made by linking data from the Cancer Registry with the National Health Insurance Research database. All patients with a new diagnosis of MM (ICD-O-3 codes M-97323 and C42) in the cancer registry from 01 January 2000 until 31 June 2014 were included. Patients with a prior malignancy were excluded. Patients must have received at least one treatment for MM in the follow-up period with either novel agents alone, chemotherapy + novel agents, or chemotherapy alone. Patients were followed up for the occurrence of SPMs in the cancer registry from the diagnosis date until death, occurrence of the first SPM, or 31 December 2014, whichever occurred first. The incidence of SPM was calculated from the date of the first administered MM treatment. A competing risk model assessed possible effects of death on incidence rates. Results: There were 4327 eligible patients included in the cohort analysis. The mean age at diagnosis was 66.3 years (SD 11.8) and 57.8% were men. A total of 23.7% of patients received treatment with novel agents alone, 21.9% with chemotherapy + novel agents, and 54.4% with chemotherapy alone. Patients treated with novel agents were younger (mean age 64.4 years vs. 69.6 for chemotherapy + novel agents and 65.9 years for chemotherapy alone; p<0.01) and had a higher incidence of renal impairment (18.1% vs. 15.6% and 11.6%, respectively; p<0.01), whereas the co-morbidity index was lower in patients treated with chemotherapy alone (1.19, vs. 1.29 for novel agents and 1.28 for chemotherapy + novel agents; p=0.02). There were 91 (2.1%) patients who developed at least 1 SPM, of which 83.5% developed solid tumors and 16.5% developed a hematological cancer. The crude incidence of SPM per 1000 person-years from the date of first line treatment was 13.93 in patients who received chemotherapy + novel agents, 9.14 in patients receiving chemotherapy alone and 4.48 in patients who received novel agents alone (Table). In the competing risk model, the sub-distribution hazard ratio (adjusted for comorbidity index, sex, age and year of diagnosis) for developing at least one SPM was 3.34 (95% CI 1.51-7.39; p≤0.03) in patients treated with chemotherapy + novel agents, and 2.93 (95% CI 1.12-7.67 p≤0.03) in patients treated with chemotherapy alone as first line therapy in comparison with patients treated with novel agents alone. The 3-year cumulative probability was 1.88% for developing a solid SPM, and 0.47% for a hematological malignancy. The 3-year cumulative probability of developing any SPM was 0.71% in patients treated with novel agents, 4.88% after chemotherapy + novel agents, and 1.99% after chemotherapy alone (Figure). Conclusion: The availability of novel agents appears to be favorable for the prognosis of MM in terms of SPM development. This study shows that linking high quality databases increases the breadth and depth of knowledge that can be gained from real-world data and could be used in other disease areas. Disclosures Hou: Abbvie, Astellas, BMS, Celgene, Chugai, Daiichi Sankyo, IQVIA, Johnson & Johnson, Kirin, Merck Sharp & Dohme, Novartis, Pfizer, PharmaEssential, Roche, Takeda: Honoraria; Celgene: Research Funding. Liu:Janssen Research & Development: Employment, Equity Ownership. Qiu:Janssen Research & Development: Employment, Equity Ownership. Tien:Celgene: Research Funding; Alexion: Honoraria; Celgene: Honoraria; BMS: Honoraria; Novartis: Honoraria; Johnson &Johnson: Honoraria; Daiichi Sankyo: Honoraria; Roche: Honoraria; Abbvie: Honoraria; Roche: Research Funding; Pfizer: Honoraria. Tang:GSK: Consultancy; Roche: Research Funding; Pfizer: Research Funding; Janssen: Research Funding; Amgen: Research Funding.

scholarly journals Metachronous Multiple Primary Malignant Neoplasms of the Stomach and the Breast: Report of Two Cases With Review of Literature

2014 ◽  
Vol 99 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Vilvapathy Senguttuvan Karthikeyan ◽  
Sarath Chandra Sistla ◽  
Ramachandran Srinivasan ◽  
Debdatta Basu ◽  
Lakshmi C. Panicker ◽  
...  
Keyword(s):  
Malignant Neoplasm ◽  
Second Primary ◽  
Malignant Neoplasms ◽  
Rare Occurrence ◽  
Review Of Literature ◽  
Second Primary Malignancy ◽  
Carcinoma Of The Breast ◽  
Primary Malignancy ◽  
Multiple Primary ◽  
Second Primary Malignancies

Abstract Multiple primary malignant neoplasm is the occurrence of a second primary malignancy in the same patient within 6 months of the detection of first primary (synchronous), or 6 months or more after primary detection (metachronous). Multiple primary malignant neoplasms are not very frequently encountered in clinical practice. The relative risk for a second primary malignancy increases by 1.111-fold every month from the detection of the first primary malignancy in any individual. We present 2 patients treated for carcinoma of the breast who developed a metachronous primary malignancy in the stomach to highlight the rare occurrence of multiple primary malignant neoplasms. These tumors were histologically dissimilar, with distinct immunohistochemical parameters. The importance lies in carefully identifying the second primary malignancies, not dismissing them as metastases, and treating them accordingly.

scholarly journals Quadruple Multiple Primary Malignancies: Early Detection of Second Primary Malignancy by Esophagogastroduodenoscopy/Colonoscopy Is Crucial for Patients with Classic Kaposi’s Sarcoma

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 218
Author(s):  
Nobuyuki Maruyama ◽  
Yuko Okubo ◽  
Masato Umikawa ◽  
Akiko Matsuzaki ◽  
Akira Hokama ◽  
...  
Keyword(s):  
Kaposi's Sarcoma ◽  
Colon Adenocarcinoma ◽  
Kaposi’S Sarcoma ◽  
Second Primary ◽  
Second Primary Malignancy ◽  
Primary Malignancy ◽  
Multiple Primary Malignancies ◽  
Stomach Adenocarcinoma ◽  
Well Differentiated ◽  
Second Primary Malignancies

Currently, Kaposi’s sarcoma (KS) is treated following the recommendations of international guidelines. These guidelines recommend esophagogastroduodenoscopy/colonoscopy for detecting multicentric KS of visceral lesions. Second primary malignancies (SPMs) are also a common KS complication; however, information on their detection and treatment is unfortunately not yet indicated in these guidelines. This paper reports on an 86-year-old man who suffered from quadruple primary malignancies: skin classic KS with colon adenocarcinoma, oral squamous cell carcinoma (maxilla), and well-differentiated stomach adenocarcinoma. Gastric cancer was incidentally detected during esophagogastroduodenoscopy, which was performed to detect visceral KS. We suggest that esophagogastroduodenoscopy/colonoscopy be routinely performed during the follow-up of patients with KS. As SPMs are crucial complications in patients with KS, these malignancies should be detected as early as possible.

scholarly journals Second Primary Malignancies in Patients With Hepatocellular Carcinoma: A Population-Based Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Junjie Kong ◽  
Guangsheng Yu ◽  
Wei Si ◽  
Guangbing Li ◽  
Jiawei Chai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
High Risk ◽  
Risk Model ◽  
Initial Diagnosis ◽  
Competing Risk ◽  
Second Primary ◽  
Primary Malignancy ◽  
Calibration Curves ◽  
Clinical Scenarios

BackgroundSecond primary malignancy (SPM) is becoming a threat for the health of cancer survivors. However, data on the features and results of patients with hepatocellular carcinoma (HCC) with SPMs are scarce. This study aimed to explore the characteristics of HCC patients with SPMs and to screen HCC patients who are at a high risk of developing SPMs.MethodHCC patients diagnosed between 2000 and 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. Eligible patients were divided into the only one primary malignancy and SPM groups. The Fine-Gray proportional subdistribution hazards model was used to explore the risk factors of developing SPMs, and a competing-risk model was established to predict the probability of developing SPMs for HCC patients after initial diagnosis. The calibration curves, concordance index (C-index), and decision curve analysis (DCA) were used to evaluate the performance of the nomogram.ResultsA total of 40,314 HCC patients were identified, 1,593 (3.95%) of whom developed SPMs 2 months after the initial diagnosis with a maximum follow-up time of approximately 18 years. The 3-, 5-, and 10-year cumulative incidence of SPMs were 2.35%, 3.12%, and 4.51%, respectively. Age at initial diagnosis, extent of disease, tumor size, and treatment were identified as the independent risk factors of developing SPMs and integrated into the competing-risk nomogram. The C-index of the nomogram was 0.677 (95% confidence interval 0.676–0.678), and the calibration curves showed an excellent agreement between the nomogram prediction and the actual observations. Furthermore, DCA indicated that the nomogram had good net benefits in clinical scenarios.ConclusionsHCC survivors remain at a high risk of developing SPMs. The development of SPMs was associated with the clinical features and treatment strategies. A competing-risk nomogram was constructed to help surgeons identify the patients who are at a high risk of developing SPMs and contribute to the further management of SPMs.

Trends in Incidence and Survival of Multiple Myeloma with Second Primary Malignancy,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3958-3958
Author(s):  
Pedram Razavi ◽  
Kristin A Rand ◽  
Sikander Ailawadhi
Keyword(s):  
Multiple Myeloma ◽  
Randomized Clinical Trials ◽  
Conflicts Of Interest ◽  
Temporal Trends ◽  
Second Primary ◽  
Second Primary Malignancy ◽  
Primary Malignancy ◽  
Annual Percent Change ◽  
Race Ethnicity ◽  
Second Primary Malignancies

Abstract Abstract 3958 Introduction: Recent advances in the treatment of multiple myeloma (MM) have lead to improved patient outcomes and significant improvement in MM survival. Reports from ongoing randomized clinical trials have suggested that there may be an association between the types of treatment received, particularly certain novel therapeutic agents, and a higher incidence of second primary malignancies (SPM) among MM patients. In this analysis, we explored current patterns and trends in incidence and survival of MM between 1973–2008 to better characterize MM patients with second primary malignancies. Methods: We used data from the National Cancer Institute Surveillance Epidemiology and End Results Program (SEER) to examine the incidence and survival trends in MM by SPM status between 1973–2008. We included all cases with MM as the first primary malignancy and calculated the age-adjusted annual incidence rates (AIR per 100,000) stratified by those with single primary (SP) MM and those with MM as the first of multiple primaries (FMP). All cases that were not microscopically confirmed or those with an MM diagnosis coded only from autopsy- or death certificates were excluded from the analysis. We used joinpoint regression models to calculate the annual percent change (APC) and to determine the best fitting line or set of lines that describes the MM temporal trends. A Monte Carlo permutation method was used to test for significance. We used multivariate Cox proportional hazard models to estimate the hazard ratios (HR) and 95% confidence intervals (95% CI) for MM by SPM status, and all analyses were further stratified by year of diagnosis, age, sex, and race/ethnicity. Results: A total of 61,411 cases of MM were recorded in all SEER registries between the years 1973 and 2008. The final analysis included 49,801 SP and 3090 FMP cases. Overall, the AIR of MM was 5.31 (95% CI 5.26–5.36). The AIR of SP MM was 4.33 (95% CI 4.28–4.38) and 0.28 (95% CI 0.27–0.29) for FMP MM. Compared to women, men were 1.41 times (95% CI 1.38–1.44) and 1.95 times as likely to develop SP MM and FMP MM, respectively. African-Americans had the highest rate of SP MM (AIR 9.09; 95% CI 8.85–9.34) and FMP MM (AIR 0.69; 95% CI 0.62–0.76). We observed no significant trend in AIR of SP MM between 1973–2008 (APC 0.03). The rate of FMP MM was relatively stable, however we observed a small but statistically significant increasing trend in incidence between 1973 and 1992 (APC 2.9), followed by a decreasing trend between 1992 and 2008 (APC −3.2). The rate ratio of FMP to SP MM has remained stable at approximately 6% from 1973–2008. The overall hazard ratio of mortality was 0.59 (95% CI 0.56–0.61) with a median survival of 3.6 years in the FMP MM versus 1.7 years in the SP MM patients. There was a statistically significant improvement in the survival of SP MM patients over the past three decades (P for trend < 0.001), with the most prominent increase in the 2002–2008 period with a HR of 0.67 (95% CI 0.64–0.69) when compared to those diagnosed in the 1973–1981 period. In contrast, the survival of FMP MM patients remained constant (P for trend=0.39). Although SP MM patients show a significant increase in survival over time, FMP MM survival remained stable and significantly higher. We further stratified the survival analysis by age, sex, and race/ethnicity. In all stratified analyses, FMP MM patients had a significantly better outcome compared to SP MM patients. Conclusions: Although there has been significant improvement in survival for patients with SP MM in recent years, our results provide an epidemiologic evidence suggestive of a subtype of MM with a better outcome, yet a higher risk of secondary primary malignancies. The incidence rate and outcome of this possible subtype has remained unchanged over the last three decades. These findings are replicated when stratified by gender, race, age, and year of diagnosis. Recent advancements of MM treatment have seemed to only increase the survival of SP MM patients, while the survival of FMP MM patients remained stable. Further studies are needed to explore the potential genetic heterogeneity between MM with and without second primary malignancies. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Urothelial Cancer and the Diagnosis of Subsequent Malignancies

2013 ◽  
Vol 7 (1-2) ◽  
pp. 57
Author(s):  
Deepak K. Pruthi ◽  
Zoann Nugent ◽  
Piotr Czaykowski ◽  
Alain A. Demers
Keyword(s):  
Prostate Cancer ◽  
Relative Risk ◽  
Urothelial Cancer ◽  
Risk Model ◽  
Invasive Disease ◽  
Second Primary ◽  
Cancer Type ◽  
Second Primary Cancer ◽  
Second Primary Malignancy ◽  
Primary Malignancy

Purpose: We examine the likelihood of a second primary malignancy diagnosis following the diagnosis of urothelial cancer.Methods: We identified subjects from the Manitoba Cancer Registry diagnosed with urothelial cancer between April 1, 1985 and December 31, 2007. Data were collected on all subsequent new cancer diagnoses. Standardized incidence ratios (SIRs) were calculated for each major cancer type, matched with the general population by age, sex and period. Further analysis was undertaken stratifying by morphology and invasiveness. The results in males were examined with and without prostate cancer. A competing risk model was used to analyze the data controlling for death.Results: Of the 4412 included urothelial cancer cases, 712 patients (16.1%) subsequently developed a second primary malignancy. Risks were highest within 1 year of diagnosis persisting for 5 years. This risk was highest in males aged less than 70 (SIR = 6.25; 95% Confidence Interval [CI] 5.08-7.04). Overall, the risk was similarbetween the sexes (female SIR: 1.30, CI 1.09-1.54; males 1.42, CI1.31-1.54; males excluding prostate SIR: 1.22 CI 1.11-1.35). There was an increased relative risk for developing a second primary for cancers of the kidney (male), lung, breast (female) and prostate. Papillary cancers were associated with increased relative risk of developing lung, prostate, and breast (female and male) cancer.  In the competing risks model, patients diagnosed with a papillary or insitu urothelial cancer were more likely to be diagnosed with a second primary than non-papillary and invasive disease, respectively.Conclusions: Those diagnosed with urothelial cancer have an increased probability of having a second primary cancer detected within the subsequent 5 years, even when prostate cancer is excluded. Papillary tumours in particular may provide a warning for subsequent malignancy.

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