Impact of prior cancer on outcomes in nasopharyngeal carcinoma

Prior cancer history predicts the worse survival of patients with nasopharyngeal carcinoma

PURPOSE

Previous cancers can be observed in patients with nasopharyngeal carcinoma (NPC). However, whether prior cancer diagnosis affects survival outcomes remains unknown. This study aimed to explore the impact of prior cancer on the survival of patients with NPC.

METHODS

We retrospectively collected data from 666 NPC patients between 2006 and 2018. The patients in this study were divided into those without prior cancer, with prior head and neck cancer, and prior non-head and neck cancer. The demographic data and survival of these groups were then analyzed. The independent prognostic factors for NPC were determined using multivariate Cox regression analysis.

RESULTS

We identified 25 NPC patients with prior cancer in our case series, most of whom had a history of colorectal cancer. Patients with a history of cancer were older than those without a history of cancer (p = 0.001). In the subgroup analysis stratified by the timing of prior cancer, NPC patients with prior non-head and neck cancer within 24, 36, 60, and 120 months showed worse survival than patients without prior cancer (all p < 0.05). When stratified by cancer stage, stage III NPC patients with prior non-head and neck cancer showed worse survival than patients without prior cancer (p < 0.001). Prior cancer and diabetes can predict worse survival in patients with stage III NPC.

CONCLUSION

This study demonstrated that prior cancer and diabetes are independent prognostic factors in patients with stage III NPC.

Impact of prior cancer on the overall survival of patients with nasopharyngeal carcinoma

PURPOSE

Prior cancer history is an important exclusion criterion from clinical trials and may decrease their generalizability. This study aimed to investigate the impact of prior cancer on the prognosis of patients with nasopharyngeal carcinoma and to describe their characteristics.

MATERIALS AND METHODS

Data of patients with nasopharyngeal carcinoma diagnosed between 2010 and 2015 were collected from the Surveillance, Epidemiology, and End Results database. The discrepancy in baseline characteristics was adjusted by propensity score matching. Kaplan-Meier and Cox regression analyses were performed to assess the impact of prior cancer on overall survival.

RESULTS

A total of 3412 individuals were identified, of which 418 (12.25%) had prior cancer. Prostate cancer was the most frequently detected type of prior cancer (18.42%). Nearly 45% of the prior cancers were diagnosed within 5 years before the nasopharyngeal carcinoma. Patients with prior cancer had an inferior survival compared to those without prior cancer (p < 0.001). Notably, patients with prior prostate, breast, hematological, and nasopharyngeal cancers had a non-inferior overall survival. Prior cancer history was an independent factor of poor overall survival (hazard ratio = 1.329, p = 0.003).

CONCLUSIONS

This is the first study to provide the comprehensive insight that patients with nasopharyngeal carcinoma and prior cancer have lower overall survival. Different prior cancer types had a different impact on the clinical outcome, suggesting that the exclusion criteria should be individually defined by unique cancer types.

The impact of a prior malignancy on outcomes in gastric cancer patients

Background

The number of cancer survivors has increased rapidly, and there is a higher risk of developing a second cancer. Whether a prior malignancy could affect survival outcomes is unknown. We aimed to investigate the clinical characteristics and prognostic outcomes of prior malignancies in patients with gastric cancer.

Methods

Patient data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We used the Kaplan–Meier method, competing risk models, and Cox regression models to evaluate the impact of prior malignancy on survival outcomes.

Results

Among 71,809 patients with primary gastric cancer, 6667 (9.3%) patients had a pre‐existing cancer. Prostate (31.86%), breast (14.34%), and colon and rectum (10.32%) cancer were the most common types. A significant difference was observed in the overall survival rates between patients with and without prior cancer (log‐rank=139.73, p < 0.001). In the subgroup analysis, patients with prostate, uterine corpus, lung and bronchus, colon and rectum, esophagus, urinary bladder, leukemia, brain and other nervous system, oral cavity and pharynx, and breast cancer faced inferior survival than those without prior cancer.

Conclusions

A history of prior cancer was associated with worse overall survival in patients with gastric cancer, and the effects varied by different initial cancer types. The exclusion and inclusion of patients who had previous malignancies should be reconsidered according to the specific malignancy types.

Impact of Prior Cancer on the Prognosis of Patients With Laryngeal Cancer: A Population-Based Study Using the Surveillance, Epidemiology, and End Results Database

Background: Little is known about the clinical significance of laryngeal cancer as a subsequent tumor. We aimed to determine the impact of a prior cancer history on the prevalence and prognosis of patients with laryngeal cancer. Methods: We retrospectively reviewed patients diagnosed with laryngeal cancer between 2004 and 2011 in the Surveillance, Epidemiology, and End Results (SEER) database. The t-test and chi-squared test were used to compare variables as appropriate. Matched 1:1 case control-adjusted Kaplan-Meier analyses and Cox regression models were performed to investigate the impact of prior cancer on overall survival (OS). Results: Among 20,987 patients with laryngeal cancer, nearly one-fifth (n = 3,915, 18.65%) had a prior cancer. The top three common prior cancers were prostate (588, 28.1%), lung and bronchus (354, 16.9%), and head and neck (306, 14.6%). A total of 73.4% of the prior cancers were diagnosed within 5 years of the laryngeal cancer diagnosis. Compared to patients without prior cancer, a worse survival was significantly associated with a prior cancer among laryngeal cancer patients, regardless of the interval time of the prior cancer (log-rank tests P < 0.001). Furthermore, prior cancer was an independent predictor of worse OS based on the Cox regression model [hazard ratio (HR) = 1.396, 95% confidence interval, 1.336-1.458]. In addition, patients with prior lung and bronchus cancer tended to have the worst survival (log-rank tests P < 0.001). Conclusions: Prior cancer has an adverse effect on clinical outcomes among patients with laryngeal cancer. These results suggest that individualized treatment should be seriously considered in patients with laryngeal cancer and a history of prior cancer, regardless of the interval time of prior cancer.